Optimum treatment strategy for superficial esophageal cancer: Endoscopic mucosal resection versus radical esophagectomy

This study was designed to determine the optimum treatment for a superficia l esophageal cancer involving the mucosal or suhmucosal layer of the esopha gus, The subjects were 150 patients with a superficial esophageal cancer wh o underwent endoscopic mucosal resection (EMR) or esophagectomy in Kurume U niversity Hospital from 1981 to 1997, Tile mortality and morbidity rates, s urvival rate, and recurrence rate were retrospectively compared for (1) 35 patients who underwent EMR and 37 patients who underwent esophagectomy for a mucosal esophageal cancer and (2) 45 patients who underwent extended radi cal esophagectomy and 33 patients who underwent less radical esophagectomy for a submucosal esophageal cancer. Among the 72 patients with a mucosal ca ncer, lymph node metastasis/recurrence was observed in only one (1%); where as of 78 patients with a suhmucosal cancer it was observed in 30(38%). Amon g patients with a mucosal cancer the mortality and morbidity rates after EM R were lower than for those after esophagectomy. The survival rate after EM R was the same as that after esophagectomy. No recurrence was observed afte r either treatment modality. Among the patients with a submucosal cancer, t he survival rate was higher and the recurrence rate lower after extended ra dical esophagectomy; than after less radical esophagectomy the mortality an d morbidity rates after extended radical esophagectomy were the same as tho se after less radical esophagectomy. Multivariate analysis demonstrated tha t the treatment modality (EMR versus esophagectomy) did not influence the s urvival of patients with a mucosal esophageal cancer, whereas it strongly i nfluenced the survival of patients with a suhmucosal esophageal cancer, We concluded that EMR was the mainstay; of treatment for a mucosal esophageal cancer, and extended radical esophagectomy was the mainstay of treatment fo r a submucosal esophageal cancer.