TUMOR SPREAD IN SUPERFICIAL ESOPHAGEAL CANCER - HISTOPATHOLOGIC BASISFOR RATIONAL SURGICAL-TREATMENT

To formulate a rational approach for the surgical treatment of patient s with superficial esophageal cancer (SEC), tumor spread was clinicopa thologically studied in 89 patients with SEC. There were 31 mucosal an d 58 submucosal tumors. Lymph node metastases were not found in any of those with a mucosal tumor, while one or more lymph nodes were positi ve for cancer in 41.4% of those with a submucosal tumor. Furthermore, cancer metastasized to extramediastinal nodes, including cervical and abdominal nodes, in 14 patients, accounting for 58.3 % of those with n odal metastasis. The 5-year survival rate was 100% and there were no r ecurrences after esophagectomy in those with a mucosal tumor, whereas the survival rate of those with a submucosal tumor was 64.3% at 5 year s (p < 0.01). Based on the different biological behavior of mucosal an d submucosal esophageal cancer, we conclude that mucosal tumors may be adequately treated by any type of local resection but submucosal tumo rs require a subtotal esophagectomy with systematic lymphadenectomy in volving the cervical, mediastinal, and abdominal nodes for cure.