Prognostic differences between early squamous-cell and adenocarcinoma of the esophagus

Hölscher, AH; Bollschweiler, Elfriede; Schröder, Wolfgang; Gutschow, Christian A.; Siewert, J. R.

doi:10.1093/dote/10.3.179

Cited by 34 publications

(17 citation statements)

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“…Die Rolle der Chirurgie bei schweren Mucosadysplasien, wie sie beim Endobrachyoesophagus vorliegen können, ist umstritten. Aufgrund der nicht vernachlässigbaren Morbidität (bis zu 50 %) und Letalität (6±10 %) [3,8] ist die Evaluation alternativer minimal-invasiver Therapieverfahren, gerade bei chirurgischen ¹Hochrisikopatientenª, wün-schenswert. Verschiedene endoskopische Therapieverfahren wie die Mucosektomie, die thermische Lasercoagulation, die Elektrocoagulation und die photodynamische Therapie (PDT) kommen bei kurativer Zielsetzung in Betracht.…”

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“…In diesem Spannungsfeld ist es zwingend notwendig, durch prospektive, multizentrische Studien sowohl abgesicherte Informationen über den natürlichen Verlauf der Erkrankung als auch gesicherte Ergebnisse zum kurativen Potential endoskopisch-ablativer Verfahren wie der photodynamischen Therapie (PDT) zu erreichen. Auf Basis der in offener Studie gewonnenen Erfahrungen von Overholt und Panjehpour [8] vergleicht eine solche international multizentrische Studie zur Zeit PDT mit Photofrin randomisiert mit dem Spontanverlauf unter Säuresuppression. Dabei wird auch in Anbetracht des Risikos okkulter Carcinome eine Dosis gewählt, bei der ein Stenoserisiko von etwa 30 % akzeptiert werden muû.…”

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Photodynamische Ablation und Argon-Plasmacoagulation von prämalignen und frühmalignen Läsionen des Oesophagus Eine Alternative zur Chirurgie?

Orth

Stănescu

Rück

et al. 1999

Chirurg

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Eleven patients with high-grade mucosal dysplasia in a columnar-lined oesophagus and 2 patients with a squamous carcinoma (uT1) underwent photodynamic therapy (PDT) and argon-plasma coagulation (APC). For PDT, 5-aminolevulinic acid (5-ALA) was given orally (60 mg/kg) and treated endoscopically with a light dose of 150 J/cm2 (100 mW/cm2) at 635 nm 4-6 h later. A second PDT was performed under the same conditions 2-3 weeks later. Patients who received APC were treated 4 times on average to reach radical Barrett mucosa eradication. All patients were consistently given medication to suppress acid production. No complications occurred in either group. Follow-up endoscopies and multiple biopsies for 3-42 months showed squamous regeneration in the dysplastic columnar-lined oesophagus in all 11 patients. Two patients with squamous carcinoma were found to have a recurrence 9 and 12 months later. PDT with 5-ALA-induced endogenous prophyrins, as well as APC combined with omeprazole protection, can eradicate superficial high-grade dysplastic mucosa in Barrett's oesophagus. However, we did not succeed in destroying a manifest carcinoma.

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Photodynamische Ablation und Argon-Plasmacoagulation von prämalignen und frühmalignen Läsionen des Oesophagus Eine Alternative zur Chirurgie?

Orth

Stănescu

Rück

et al. 1999

Chirurg

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“…It is generally accepted that the nodal status in patients with esophageal carcinoma is a major prognostic factor [10,13]. Reports have shown that adequate lymphadenectomy can improve the prognosis if the lymph node ratio of infiltrated to removed lymph nodes is less than 0.2 to 0.3 [10,14].…”

Section: Discussionmentioning

confidence: 99%

Lesser curvature lymph node metastases with esophageal squamous cell carcinoma: Implications for gastroplasty

et al. 2001

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The creation of a gastric tube after subtotal esophagectomy includes resection of the lesser curvature and abdominal lymph nodes. The fundus rotation gastroplasty has been recently proposed as an alternative technique of reconstruction that preserves the vascular arcade of the lesser curvature. This study investigates the number of resected and metastatic lymph nodes associated with abdominal lymphadenectomy to assess the oncologic radicality of fundus rotation gastroplasty. In this prospective clinical trial a two-field lymphadenectomy was performed in 39 patients with squamous cell carcinoma of the esophagus. The abdominal lymphadenectomy included partial resection of compartment I (lymph node groups 1, 2, and 3) and compartment II (lymph node groups 7, 8, 9, and 11). A meticulous workup of the specimen allowed an exact classification of specific lymph node groups and their metastatic status. After two-field lymphadenectomy a total of 1170 lymph nodes (average 30.0) including 690 abdominal lymph nodes with an average of 17.7 per patient were resected. Metastatic disease was found in 27 of 39 patients (pN1 69.2%), with metastatic growth in 116 of 867 resected lymph nodes (13.4%). Of the 27 pN1 patients, 21 had abdominal lymph node metastases. Metastatic lymph nodes at the lesser curvature (groups 1, 3, and 7) were detected in 11.7%, 16.7%, and 29.7% of the resected lymph nodes, respectively. Of the 21 patients (85.7%) with abdominal lymph node metastases, 18 had positive lymph nodes at the lesser curvature. Squamous cell carcinoma of the esophagus is associated with a high rate of lymph node metastases at the lesser curvature and the left gastric artery. Therefore preservation of the lesser curvature and the left gastric artery for gastroplasty reduces the radicality regarding lymph node metastases.

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“…Despite excellent curative results in patients with early carcinomas, resection, as an invasive method, continues to be encumbered by relatively high morbidity rates (15-50%) and mortality rates (3.3-20.0%) that vary between surgical centers and community hospitals. 1,2,17,18 In Western countries, until recently, local endoscopic treatment for patients with early carcinoma of the esophagus has been restricted either to inoperable patients or to those who refused to undergo surgery. Therefore, the extent of experience reported in the literature, with the exception of Asian sources, remains limited.…”

Section: Discussionmentioning

confidence: 99%

“…The development of alternative, minimally invasive therapeutic concepts is desirable in view of the distinct morbidity and mortality for these patients. 1,2 Endoscopic therapy of the esophagus plays a particularly important role in surgical high risk patients or inoperable patients. If therapy has a curative objective, endoscopic mucosectomy, nonselective thermic laser coagulation or electrocoagulation, as well as photodynamic therapy (PDT) can be taken into consideration as potential treatment options.…”

mentioning

confidence: 99%

Photodynamic destruction of high grade dysplasia and early carcinoma of the esophagus after the oral administration of 5-aminolevulinic acid

Goßner¹,

May²,

Sroka³

et al. 1999

Cancer

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Prognostic differences between early squamous-cell and adenocarcinoma of the esophagus

Cited by 34 publications

References 0 publications

Photodynamische Ablation und Argon-Plasmacoagulation von prämalignen und frühmalignen Läsionen des Oesophagus Eine Alternative zur Chirurgie?

Photodynamische Ablation und Argon-Plasmacoagulation von prämalignen und frühmalignen Läsionen des Oesophagus Eine Alternative zur Chirurgie?

Lesser curvature lymph node metastases with esophageal squamous cell carcinoma: Implications for gastroplasty

Photodynamic destruction of high grade dysplasia and early carcinoma of the esophagus after the oral administration of 5-aminolevulinic acid

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