Visceral Surgery Department, Geneva University Hospital, Geneva, Switzerland.
Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland.
Ann N Y Acad Sci. 2018 Dec;1434(1):115-123. doi: 10.1111/nyas.13955. Epub 2018 Aug 23.
Early carcinomas of the esophagus are histologically classified as adenocarcinoma or squamous cell carcinoma and microscopically subdivided into mucosal and submucosal carcinomas depending on infiltration depth. The prevalence of lymph node metastasis in mucosal carcinoma remains low. However, lymph node metastases arise frequently from tumors with submucosal infiltration, with increasing prevalence in the deeper submucosal sublayers. According to current German guidelines, endoscopic resection is the recommended treatment in mucosal adenocarcinoma without histologic risk factors (lymphatic invasion 1, vascular invasion 1, >grade 2, R1-margin). In superficial submucosal infiltration without histologic risk factors, endoscopic resection can be considered. In squamous cell carcinoma, endoscopic resection is indicated up to middle layer mucosal carcinoma. Beyond these criteria, surgical resection should be considered. The gold standard is a subtotal transthoracic esophagectomy with two-field lymphadenectomy. Total esophagectomy is performed in cervical esophageal carcinoma and transhiatal extended gastrectomy in carcinoma of the cardia. Minimally invasive procedures show good oncologic results and reduce the morbidity of radical esophagectomy. Reduced morbidity might be an argument for surgical resection in borderline cases between endoscopic and surgical resection. In early squamous cell cancer, the combination of endoscopic resection and adjuvant chemoradiotherapy is a therapeutic option with promising results.
早期食管癌在组织学上可分为腺癌或鳞状细胞癌，并根据浸润深度分为黏膜癌和黏膜下癌。黏膜癌的淋巴结转移率仍然较低。然而，来源于黏膜下浸润的肿瘤常发生淋巴结转移，且随着黏膜下更深层的浸润，其转移率也逐渐升高。根据目前的德国指南，对于无组织学危险因素的黏膜腺癌（淋巴管浸润 1、血管浸润 1、> 2 级、R1 切缘），推荐内镜下切除作为治疗方法。对于无组织学危险因素的浅表黏膜下浸润，可考虑内镜下切除。对于鳞状细胞癌，内镜下切除适用于中黏膜层癌。超出这些标准，应考虑手术切除。金标准是经胸食管次全切除术和两野淋巴结清扫术。颈段食管癌行全食管切除术，贲门部食管癌行经膈扩大胃切除术。微创方法显示出良好的肿瘤学结果，并降低了根治性食管切除术的发病率。在介于内镜和手术切除之间的边缘病例中，发病率的降低可能是手术切除的一个论据。对于早期鳞状细胞癌，内镜切除联合辅助放化疗是一种具有良好疗效的治疗选择。
