Manner Hendrik, Pech Oliver, Heldmann Yvonne, May Andrea, Pauthner Michael, Lorenz Dietmar, Fisseler-Eckhoff Annette, Stolte Manfred, Vieth Michael, Ell Christian
Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Klinik Innere Medizin II, HSK Wiesbaden, Ludwig-Erhard-Strasse 100, 65199, Wiesbaden, Germany,
Surg Endosc. 2015 Jul;29(7):1888-96. doi: 10.1007/s00464-014-3881-3. Epub 2014 Oct 8.
A prerequisite for endoscopic treatment (ET) of not only mucosal, but also submucosal early adenocarcinoma of the esophagus (EAC) would be a rate of lymph node (LN) metastasis below the mortality rate of esophagectomy (2-5%). The aim of the present study was to evaluate the rate of LN metastasis in patients with pT1b sm1 EAC.
1996-2010, 1,718 patients with suspicion of EAC were referred to the Department of Internal Medicine II at HSK Wiesbaden. In 123/1718 patients, the suspicion (endoscopic ultrasound, EUS) or definitive diagnosis of sm1 EAC (ER/surgery) was made. Rate of LN metastasis was analyzed separately for low-risk (LR; G1-2, L0, V0) and high-risk lesions (HR; G3, L1, V1; ≥ 1 risk factor). LN metastasis was only evaluated in patients who had a proven maximum invasion depth of sm1 (ER and/or surgery), and who in case of ET had a follow-up (FU) by EUS of at least 24 months.
Of the 72/123 patients included into the study, 49 patients had LR (68%) and 23 HR lesions (32%). In endoscopically treated LR patients (37/49), mean EUS-FU was 60 ± 30 mo (range 25-146); in HR patients undergoing ET (6/23), it was 63 ± 17 mo (46-86; p = 0.4). Mean number of resected LN was 27 ± 16 (12-62) in operated LR patients and 27 ± 10 (12-47) in HR-patients. The rate of LN metastasis was 2% in the LR (1 patient) and 9% in the HR group (2 patients; p = 0.24). Mortality of esophagectomy was 3%.
The rate of LN metastasis in pT1b sm1 early adenocarcinoma with histological LR pattern was lower than the mortality rate of esophagectomy. ER may therefore be used alternatively to surgery in this group of patients.
不仅食管黏膜早期腺癌，而且食管黏膜下早期腺癌的内镜治疗（ET）的一个前提条件是淋巴结（LN）转移率低于食管切除术的死亡率（2%-5%）。本研究的目的是评估pT1b sm1期食管腺癌患者的LN转移率。
1996年至2010年，1718例疑似食管腺癌患者被转诊至威斯巴登HSK医院的内科二部。在123/1718例患者中，通过内镜超声（EUS）怀疑或确诊为sm1期食管腺癌（内镜切除/手术）。分别分析低风险（LR；G1-2、L0、V0）和高风险病变（HR；G3、L1、V1；≥1个风险因素）的LN转移率。仅对已证实最大浸润深度为sm1（内镜切除和/或手术）且在内镜治疗后通过EUS进行至少24个月随访（FU）的患者评估LN转移情况。
纳入本研究的72/123例患者中，49例为LR（68%），23例为HR病变（32%）。在内镜治疗的LR患者（37/49）中，平均EUS随访时间为60±30个月（范围25-146个月）；在接受内镜治疗的HR患者（6/23）中，为63±17个月（46-86个月；p = 0.4）。接受手术的LR患者平均切除的LN数量为27±16个（12-62个），HR患者为27±10个（12-47个）。LR组的LN转移率为2%（1例患者），HR组为9%（2例患者；p = 0.24）。食管切除术的死亡率为3%。
组织学类型为LR的pT1b sm1期早期腺癌的LN转移率低于食管切除术的死亡率。因此，在这组患者中，内镜切除可替代手术使用。
