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Depth of Submucosal Tumor Infiltration and Its Relevance in Lymphatic Metastasis Formation for T1b Squamous-Cell and Adenocarcinomas of the Esophagus
Michael F. Nentwich1, Katharina Von Loga2,1, Matthias Reeh1, Guido Sauter2, Thomas RöSch3, Jakob R. Izbicki1, Dean Bogoevski*1
1General, Visceral and Thoracic Surgery, University Clinic Hamburg-Eppendorf, Hamburg, Germany; 2Dept. of Pathology, University Clinic Eppendorf, Hamburg, Germany; 3Clinic for Interdisciplinary Endoskopy, University Clinic Eppendorf, Hamburg, Germany
Background: Surgical resection for early esophageal carcinoma has been challenged by less invasive endoscopic approaches. As lymph node involvement, one of the major factors influencing patients' overall survival cannot be assessed by endoscopic resection, selecting patients in need for surgical intervention according to their risk of lymphatic spread is mandatory.
Objective: The aim of this study was to evaluate submucosal layer thickness, depth of submucosal tumor infiltration and tumor length as well as lymphatic invasion in T1b esophageal carcinomas for its predictiveness on lymphatic metastasis formation.
Methods: Histopathological specimens following surgical resection for T1b esophageal carcinomas were re-evaluated for overall submucosal layer thickness, depth of submucosal tumor infiltration, tumor length as well as lymphatic and vascular infiltration. A ratio of overall submucosal layer thickness and depth of submucosal tumor infiltration was calculated and this proportion of submucosal invasion was used to form sub-categories either in thirds or in halfs of total submucosal gauge. Influence of submucosal invasion as well as tumor length on lymphatic metastasis formation and overall survival was assessed.
Results:
A total of 67 Patients with pT1b tumors were analyzed, including 36 adenocarcinomas (53.7%) and 31 squamous-cell carcinomas (46.3%). Lymph node involvement was seen in 20.9% (14/67) patients. Overall mean thickness of submucosal layer was 5.07mm (SD 1.53mm). Overall proportion of submucosal infiltration was calculated as 64.79% (SD 29.2%). Comparison of overall proportion of submucosal infiltration between patients with (62.81%, range 17-97%) and without (65.31%, range 2-99%) lymph node involvement did not show significant differences (p= 0.698 Mann-Whitney-U). On log-regression models, only the presence of lymphangioinvasion and tumor length was significantly associated with positive lymph node involvement.
Conclusion: As depth of submucosal tumor infiltration did not correlate with the formation of lymph node metastases and in regard of the risk of lymphatic spread in these cases, surgical resection is warranted whenever the tumor invades the submucosal layer.
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