Shimizu Yuichi, Tsukagoshi Hiroyuki, Fujita Masahiro, Hosokawa Masao, Kato Mototsugu, Asaka Masahiro
Division of Endoscopy, Third Department of Internal Medicine, Hokkaido University Medical Hospital, Sapporo, Japan.
Gastrointest Endosc. 2002 Sep;56(3):387-90. doi: 10.1016/s0016-5107(02)70043-6.
Endoscopic mucosal resection is recommended for squamous cell carcinoma of the esophagus confined to the lamina propria. However, endoscopic mucosal resection is often performed in patients with tumors that invade the muscularis mucosa or upper submucosa to minimize surgical invasiveness, despite the increased risk of lymph node metastasis. This study prospectively evaluated long-term outcome in such patients.
Twenty-six consecutive patients with squamous cell esophageal carcinoma invading the muscularis mucosa or submucosa who underwent endoscopic mucosal resection from June 1992 through March 2000 (extended endoscopic mucosal resection group) were studied. As control group, 44 consecutive patients with esophageal carcinoma invading the muscularis mucosae or upper third of the submucosa and no preoperative evidence of lymph node metastasis who underwent esophagectomy during the same period (surgical resection group) were studied.
Overall survival rates at 5 years in the extended endoscopic mucosal resection group and surgical resection group were, respectively, 77.4% and 84.5%. There was no significant difference between survival distributions. Cause-specific survival rates at 5 years in extended endoscopic mucosal resection and surgical resection groups were, respectively, 95.0% and 93.5%. Survival curves for the groups were similar.
Although patients were not randomized to extended endoscopic mucosal resection or surgical resection in this study, the results suggest that endoscopic mucosal resection may be safe and effective for management of squamous cell esophageal carcinoma invading the muscularis mucosae or upper submucosa.
对于局限于固有层的食管鳞状细胞癌，推荐行内镜黏膜切除术。然而，尽管存在淋巴结转移风险增加的情况，但对于侵犯黏膜肌层或黏膜下层上部的肿瘤患者，为了将手术侵袭性降至最低，内镜黏膜切除术仍经常被实施。本研究前瞻性评估了这类患者的长期预后。
对1992年6月至2000年3月期间连续26例行内镜黏膜切除术的侵犯黏膜肌层或黏膜下层的食管鳞状细胞癌患者（扩大内镜黏膜切除术组）进行研究。作为对照组，对同期连续44例侵犯黏膜肌层或黏膜下层上三分之一且术前无淋巴结转移证据而行食管切除术的食管癌患者（手术切除组）进行研究。
扩大内镜黏膜切除术组和手术切除组的5年总生存率分别为77.4%和84.5%。生存分布之间无显著差异。扩大内镜黏膜切除术组和手术切除组的5年病因特异性生存率分别为95.0%和93.5%。两组的生存曲线相似。
尽管本研究中患者未随机分配至扩大内镜黏膜切除术或手术切除组，但结果表明内镜黏膜切除术对于治疗侵犯黏膜肌层或黏膜下层上部的食管鳞状细胞癌可能是安全有效的。
