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
Fanningerstr. 32
10365 Berlin
Phone: 0 30 / 55 18 22 10
Fax: 0 30 / 55 18 22 50
Email: hj.schulz@sana-kl.de