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Lymph Node Metastasis in Early Esophageal Adenocarcinoma

Lookup NU author(s): Professor Michael Griffin, Professor Alastair BurtORCiD, Neil Jennings


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Objective: To accurately document the incidence of lymph node metastases (LNM) in early esophageal adenocarcinoma with regard to the depth of invasion of the mucosa or submucosa.Background: Endoscopic therapy is now being proposed as a viable treatment for submucosal esophageal adenocarcinoma. If such treatments are appropriate, then the risk of LNM must be shown to be low in these tumors.Methods: One hundred nineteen consecutive patients underwent radical esophagectomy alone for treatment of superficial esophageal adenocarcinoma or high-grade dysplasia. The resection specimens were analyzed by an expert gastrointestinal pathologist and the presence of LNM and the depth of tumor invasion were recorded. Depth of invasion was classified as either confined to the mucosa, the first third of the submucosa, the middle third of the submucosa, or the final third of the submucosa.Results: Fifty-four patients had high-grade dysplasia or tumors confined to the mucosa with no evidence of LNM (0/54, 0%), 65 patients had tumor invading the submucosa with 8 patients having LNM (8/65, 12%). Subclassification of submucosal invasion showed that 5 of 22 "first third of the submucosa" tumors had LNM (23%), 1 of 24 "middle third of the submucosa" tumors had LNM (4%), and 2 of 19 "final third of the submucosa" tumors had LNM (11%).Conclusion: Invasion of the submucosa is associated with significant risk of LNM. Patients with submucosal invasion are not suitable for endoscopic treatment and surgical resection remains the gold standard treatment for patients with submucosal adenocarcinoma who are fit to undergo the procedure.

Publication metadata

Author(s): Griffin SM, Burt AD, Jennings NA

Publication type: Article

Publication status: Published

Journal: Annals of Surgery

Year: 2011

Volume: 254

Issue: 5

Pages: 731-737

Print publication date: 01/11/2011

ISSN (print): 0003-4932

ISSN (electronic): 1528-1140

Publisher: Lippincott Williams & Wilkins


DOI: 10.1097/SLA.0b013e318236048b


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