Superficial esophageal carcinoma: a clinicopathological review of 59 cases

During the period from 1975 to 1989, a total of 59 patients with superficial esophageal carcinoma (SEC) were operated on in our Surgical Clinic. Forty patients of the 59 (68%) had been treated during the previous 5 yr. Although 22 patients (37%) complained of slight esophageal symptoms, 12 patients had only symptoms unrelated to esophageal disease, and 25 patients were asymptomatic. In the latter patients, the lesion was found by chance at the time of screening or follow-up examination of upper gastrointestinal tract disease. Endoscopy was very useful for the diagnosis of SEC, and Lugol's solution staining technique was an effective adjunctive means. The lesions in about half of the patients were initially diagnosed by endoscopy in our series. Radiologic diagnosis of the lesions confined to the mucosal epithelium or lamina propria was particularly difficult. Lymph node metastasis was not observed in patients with intraepithelial or mucosal carcinoma. However, the metastasis was demonstrated in 18 of 38 patients (47%) with submucosal invasion. The 5-yr survival rate of patients with SEC was 73%, which was significantly superior to that of patients with advanced esophageal carcinoma (26%). Since the prognosis for the patients with submucosal invasion and lymph node metastasis was poor, we should be enthusiastic about extended lymph node dissection in the surgical treatment for patients in whom submucosal invasion is suspected.