Early esophageal cancer: the significance of surgery, endoscopy, and chemoradiation

Ann N Y Acad Sci. 2018 Dec;1434(1):115-123. doi: 10.1111/nyas.13955. Epub 2018 Aug 23.

Abstract

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.

Keywords: chemoradiotherapy; early esophageal cancer; endoscopic resection.

Publication types

  • Review

MeSH terms

  • Carcinoma, Squamous Cell* / diagnosis
  • Carcinoma, Squamous Cell* / pathology
  • Carcinoma, Squamous Cell* / therapy
  • Chemoradiotherapy / methods*
  • Esophageal Neoplasms* / diagnosis
  • Esophageal Neoplasms* / pathology
  • Esophageal Neoplasms* / therapy
  • Esophagectomy / methods*
  • Esophagoscopy / methods*
  • Esophagus / pathology
  • Esophagus / surgery
  • Humans
  • Lymph Node Excision
  • Lymphatic Metastasis
  • Neoplasm Staging