Clin Endosc.  2014 Nov;47(6):523-529. 10.5946/ce.2014.47.6.523.

Lymph Node Metastases in Esophageal Carcinoma: An Endoscopist's View

Affiliations
  • 1Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea.
  • 2Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University School of Medicine, Iksan, Korea. medcsc@wmc.wonkwang.ac.kr
  • 3Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
  • 4Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
  • 5Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 6Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 7Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
  • 8Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
  • 9Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
  • 10Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
  • 11Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
  • 12Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
  • 13Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.

Abstract

One of the most important prognostic factors in esophageal carcinoma is lymph node metastasis, and in particular, the number of affected lymph nodes, which influences long-term outcomes. The esophageal lymphatic system is connected longitudinally and transversally; thus, the pattern of lymph node metastases is very complex. Early esophageal cancer frequently exhibits skipped metastasis, and minimal surgery using sentinel node navigation cannot be performed. In Korea, most esophageal cancer cases are squamous cell carcinoma (SCC), although the incidence of adenocarcinoma has started to increase recently. Most previous reports have failed to differentiate between SCC and adenocarcinoma, despite the fact that the Union for International Cancer Control (7th edition) and American Joint Committee on Cancer staging systems both consider these separately because they differ in cause, biology, lymph node metastasis, and outcome. Endoscopic tumor resection is an effective and safe treatment for lesions with no associated lymph node metastasis. Esophageal mucosal cancer confined to the lamina propria is an absolute indication for endoscopic resection, and a lesion that has invaded the muscularis mucosae can be cured by local resection if invasion to the lymphatic system has not occurred.

Keyword

Esophageal neoplasms; Lymph node metastasis; Endoscopic resection
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