Objective: The objective of this study was to assess the prevalence of lymphatic spread and differences in overall survival in patients with early (T1) squamous cell carcinoma (SCC) and adenocarcinoma (AC) after resection and lymphadenectomy.
Background: Limited endoscopic approaches without lymphadenectomy are increasingly applied in patients with early esophageal cancer.
Material and Methods: In the period between April 1992 and September 2004, 368 patients with resectable carcinomas of the oesophagus had undergone oesophagectomy. Early oesophageal carcinoma was detected in 29 (14.6%) out of 198 patients with SCC and in 34 (20%) out of 170 patients with AC. Specimens were assessed for prevalence of lymphatic spread. Prognostic factors were determined by univariate and multivariate analysis.
Results: None of the 18 patients with SCC or AC limited to the mucosa (T1a) had lymphatic infiltration, as compared with 10 of 45 with infiltration of submucosa (T1b). Lymphatic spread was more common in patients with submucosal AC as compared with submucosal SCC (26.1% versus 18.2%). Although the detection of lymphatic involvement was higher in AC, the overall survival was significantly better than in SCC patients (median survival 86 months AC vs. 38 months SCC, Log-Rank p=0.046). Furthermore, the survival benefit for AC patients without nodal involvement was even higher (median survival 88 months AC vs. 32 months SCC, Log-Rank p=0.006). On multivariate analysis, only histological tumor type (AC) and grading (G1&2) were independent predictors of long-term survival.
Discussion: Prevalence of lymphatic spread as well as long-term prognosis differ markedly between early (pT1) esophageal SCC and AC. Limited resection accompanied by lymphadenectomy is warranted in these patients.