title: Esophagectomy for superficial esophageal cancer after non-curative endoscopic resection.
abstract: BACKGROUND
  Additional surgical treatment after non-curative endoscopic resection for superficial esophageal cancer should be considered unless the tumor is pathologically proven to be categorized within the absolute indication of endoscopic resection. However, the significance of this treatment strategy has been poorly evaluated until now.
  
  
  METHODS
  Additional esophagectomy with lymph node dissection was carried out for a total of 34 patients with esophageal cancer pathologically diagnosed as in contact with or invading the muscularis mucosa (pT1a-MM) or submucosa (pSM) and/or accompanying vascular permeation after endoscopic resection. The surgical results, pathological diagnosis after esophagectomy, and outcomes were analyzed.
  
  
  RESULTS
  The pathological diagnosis after endoscopic resection revealed pT1a-MM in 7 patients, pSM in 27 patients, and vessel permeation in 24 patients. The approach to esophagectomy was via right and left thoracotomy in 26 patients and 2 patients, respectively, and was transhiatal in 6 patients. Three-field lymph node dissection was performed in 12 patients, and the mean number of dissected lymph nodes was 72 (range 31-132). Pathological lymph node metastasis was noted in 10 patients. Postoperative complications developed in 10 patients, and death due to pulmonary complications was observed in one patient. No postoperative recurrence was observed during the follow-up period (1-87 months).
  
  
  CONCLUSIONS
  Esophagectomy after endoscopic resection provides favorable disease control for esophageal cancer with pT1a-MM/pSM and/or vessel permeation, while strict consideration is required to determine the indication and procedure for surgery because of its invasiveness.
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Saeki
authors.forename: Masayuki
authors.initials: M
authors.lastname: Watanabe
authors.forename: Shinji
authors.initials: S
authors.lastname: Mine
authors.forename: Hironobu
authors.initials: H
authors.lastname: Shigaki
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Oya
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Ishiyama
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Tsuchida
authors.forename: Junko
authors.initials: J
authors.lastname: Fujisaki
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sano
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D004945:Esophagoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
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