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Endoskopie heute 2011; 24(2): 117-123
DOI: 10.1055/s-0031-1271538
Originalarbeit

© Georg Thieme Verlag KG Stuttgart ˙ New York

Das Risiko von Lymphknotenmetastasen bei tieferer Invasion von frühen Adenokarzinomen des Ösophagus und der Kardia: Eine Untersuchung auf der Basis von endoskopischen Resektaten

Risk of Lymph Node Metastasis Associated with Deeper Invasion by Early Adenocarcinoma of the Esophagus and Cardia: Study Based on Endoscopic Resection SpecimensL. Alvarez Herrero1 , 2 , R. E. Pouw2 , F. G. I. van Vilsteren2 , F. J. W. ten Kate3 , M. Visser3 , M. I. van Berge Henegouwen4 , B. L. A. M. Weusten1 , J. J. G. H. M. Bergman2
  • 1Department of Gastroenterology and Hepatology, St. Antoniushospital, Nieuwegein, Netherlands
  • 2Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands
  • 3Department of Pathology, Academic Medical Center, Amsterdam, Netherlands
  • 4Department of Surgery, Academic Medical Center, Amsterdam, Netherlands
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Publication History

Publication Date:
18 July 2011 (online)

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Zusammenfassung

Hintergrund: Die meisten Angaben zum Lymphknotenmetastasen-Risiko bei Adenokarzinomen des Ösophagus und der Kardia (AEC) mit Invasion in die Muscularis mucosae (M3) oder Submukosa stützen sich auf chirurgische Serien. Diese Stu­die hat zum Ziel, die Rate von Lymphknoten­metastasen mit M3- und Submukosa-Infiltrationen der AEC in endoskopischen Resektaten zu korrelieren. Methoden: In die Studie wurden Patienten eingeschlossen, die zwischen Januar 2000 und März 2008 in 2 Zentren eine endoskopische Resektion wegen eines AEC erhalten hatten und deren endoskopische Resektate eine M3- oder Submu­kosa-Infiltration zeigten. Die Infiltrationen in die Muscularis mucosae wurde als M3 definiert. Die Submukosainvasion wurde als SM1 (< 500 mm) oder SM2 / 3 (> 500 mm) klassifiziert. Ausschlusskriterien waren Chemotherapie oder Radiotherapie und nicht-radikale endoskopische Resektionen. Ergebnisse: Es wurden 82 Patienten eingeschlossen: 57 mit M3-, 12 SM1- und 13 mit SM2- / 3-Karzinomen. Von den Tumoren waren 13 schlecht differenziert und 5 zeigten eine Lymphgefäß­invasion. Nach initialer endoskopischer Resek­tion erhielten 7 Patienten eine Operation und 75 eine endoskopische Therapie. In 158 Lymphknoten der Ösophagektomiepräparate konnten keine Lymphknotenmetastasen nachgewiesen werden. Bei keinem der endoskopisch behandelten Patienten wurde im mittleren Follow-up von 26 Monaten (Interquartile range [IQR] 14–41) Lymphknotenmetastasen diagnostiziert . Schlussfolgerung: Diese Studie zeigt, dass das Lymphknotenmetastasenrisiko von M3- und submukosalen AEC niedriger zu sein scheint als auf der Basis chirurgischer Serien angenommen und dass die gegenwärtigen Leitlinien die endoskopische Therapie von M3-AECs betreffend valide sind. Die Studie zeigt auch, dass ausgewählte Patienten mit submukosalem Karzinom für das endoskopische Management geeignet sind. Zur Bestätigung dieser Daten werden größere Serien mit längerem Follow-up benötigt. 

Abstract

Background: Most risk estimations for lymph node metastasis in adenocarcinoma of the esoph­agus and cardia (AEC) with invasion into the muscularis mucosae (m3) or submucosa are based on surgical series. This study aimed to correlate the lymph node metastasis rate with m3 and sub­mucosal infiltration depth of AEC in endo­scop­ic resection specimens. Methods:  Patients undergoing endoscopic resection for AEC between January 2000 and March 2008 at two centers were included if the endo­scopic resection specimen showed m3 or sub­mucosal cancer. Infiltration into the muscularis mucosae was defined as m3. Submucosal inva­sion was classified as sm1 (≤ 500 µm) or sm2 / 3 (> 500 µm). Exclusion criteria were chemotherapy or radiotherapy and nonradical endoscopic resection. Results: 82 patients included 57 with m3, 12 with sm1, and 13 with sm2 / 3 cancers. Of the tumors, 13 were poorly differentiated and five showed lymphovascular invasion. After initial endoscopic resection, seven patients underwent surgery and 75 endoscopic therapy. No lymph node metastases were found in 158 lymph nodes of the esophagectomy specimens and none of the endoscopically treated patients were diagnosed with lymph node metastasis during a median follow-up of 26 months (interquartile range [IQR] 14–41). Conclusion: This study suggests that lymph node metastasis risk for m3 and submucosal AEC may be lower than has been assumed on the basis of surgical series, and that current guidelines are ­valid regarding suitability of m3 AECs for endo­scopic therapy. It may also suggest that selected patients with submucosal cancers are also eligi­ble for endoscopic management. Confirmation of these results is needed in larger series with longer follow-up.

Schlüsselwörter

Ösophagus - Kardia - endoskopische Resektion - Lymphknotenmetastasenrisiko

Key words

Esophagus - Cardia - endoscopic resection - risk of lymph node metastasis

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Prof. Dr. med. H.-J. Schulz

Sana Klinikum Lichtenberg · Klinik für Innere Medizin I / Gastroenterologie

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