Early esophageal cancer: Pattern of lymphatic spread and prognostic factors for long-term survival after surgical resection

Objective: The objective of this study was to assess the prevalence and pattern of lymphatic spread in patients with early squamous cell and adenocarcinoma and identify prognostic factors for long-term survival after resection and lymphadenectomy. Summary Background Data: Limited endoscopic approaches without lymphadenectomy are increasingly applied in patients with early esophageal cancer. Material and Methods: A total of 290 patients with early esophageal cancer (157 adenocarcinoma, 133 squamous cell cancer) had surgical resection with systematic lymphadenectomy. Specimens were assessed for prevalence and pattern of lymphatic spread. Prognostic factors were determined by multivariate analysis. Results: None of the 70 patients with adenocarcinoma limited to the mucosa had lymphatic spread, as compared with 2 of 26 with mucosal squamous cell cancer. Lymphatic spread was more common in patients with submucosal squamous cell cancer as compared with submucosal adenocarcinoma (36.4% versus 20.7%). Although lymph node metastases were usually limited to locoregional lymph node stations in early adenocarcinoma, distant lymphatic spread was frequent in early squamous cell cancer. On multivariate analysis, only histologic tumor type and the presence of lymph node metastases were independent predictors of long-term survival. Five-year survival rate was 83.4% for early adenocarcinoma versus 62.9% for early squamous cell cancer and 48.2% versus 79.5% for patients with/without lymphatic spread. Discussion: Prevalence and pattern of lymphatic spread as well as long-term prognosis differ markedly between early esophageal squamous cell and adenocarcinoma. Limited resection techniques and individualized lymphadenectomy strategies appear applicable in patients with early adenocarcinoma.