Fujita H, Sueyoshi S, Yamana H, Shinozaki K, Toh U, Tanaka Y, Mine T, Kubota M, Shirouzu K, Toyonaga A, Harada H, Ban S, Watanabe M, Toda Y, Tabuchi E, Hayabuchi N, Inutsuka H
Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka 830-0011, Japan.
World J Surg. 2001 Apr;25(4):424-31. doi: 10.1007/s002680020053.
This study was designed to determine the optimum treatment for a superficial esophageal cancer involving the mucosal or submucosal layer of the esophagus. The subjects were 150 patients with a superficial esophageal cancer who underwent endoscopic mucosal resection (EMR) or esophagectomy in Kurume University Hospital from 1981 to 1997. The mortality and morbidity rates, survival 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 radical esophagectomy and 33 patients who underwent less radical esophagectomy for a submucosal esophageal cancer. Among the 72 patients with a mucosal cancer, lymph node metastasis/recurrence was observed in only one (1%); whereas of 78 patients with a submucosal cancer it was observed in 30 (38%). Among patients with a mucosal cancer the mortality and morbidity rates after EMR were lower than for those after esophagectomy. The survival rate after EMR was the same as that after esophagectomy. No recurrence was observed after either treatment modality. Among the patients with a submucosal cancer, the survival rate was higher and the recurrence rate lower after extended radical esophagectomy; than after less radical esophagectomy; the mortality and morbidity rates after extended radical esophagectomy were the same as those after less radical esophagectomy. Multivariate analysis demonstrated that the treatment modality (EMR versus esophagectomy) did not influence the survival of patients with a mucosal esophageal cancer, whereas it strongly influenced the survival of patients with a submucosal 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 for a submucosal esophageal cancer.
本研究旨在确定针对累及食管黏膜或黏膜下层的表浅食管癌的最佳治疗方法。研究对象为1981年至1997年在久留米大学医院接受内镜黏膜切除术（EMR）或食管切除术的150例表浅食管癌患者。对以下两组患者的死亡率、发病率、生存率和复发率进行了回顾性比较：（1）35例行EMR的黏膜食管癌患者和37例行食管切除术的黏膜食管癌患者；（2）45例行扩大根治性食管切除术的黏膜下食管癌患者和33例行次根治性食管切除术的黏膜下食管癌患者。在72例黏膜癌患者中，仅1例（1%）出现淋巴结转移/复发；而在78例黏膜下癌患者中，有30例（38%）出现淋巴结转移/复发。在黏膜癌患者中，EMR后的死亡率和发病率低于食管切除术后。EMR后的生存率与食管切除术后相同。两种治疗方式后均未观察到复发。在黏膜下癌患者中，扩大根治性食管切除术后的生存率更高，复发率更低；扩大根治性食管切除术后的死亡率和发病率与次根治性食管切除术后相同。多因素分析表明，治疗方式（EMR与食管切除术）对黏膜食管癌患者的生存无影响，而对黏膜下食管癌患者的生存有显著影响。我们得出结论，EMR是黏膜食管癌的主要治疗方法，扩大根治性食管切除术是黏膜下食管癌的主要治疗方法。
