It is rather a non specific question. Is it a T1a SCC or higher? T1a (mucosal disease) can be dealt with local - endoscopic treatment (EMR/ESD). Any case higher than T1b (submucosal) should, ideally, undergo a total esophagectomy. If this is not possible, then the proximal margin should be at least 8 cm. Check the attached link J Clin Pathol. 1996 Feb;49(2):124-9.. If also you intend to do a proper lymphadenectomy, you will end up to total esophagectomy and a 3 field dissection regardless of the site of the primary disease.
http://www.ncbi.nlm.nih.gov/pubmed/8655677
literature Review ishows variable lengths 5,8,10,!2 Cm.
Endoscopic mapping need to be done.
In Practice It is recommended not to perform Thoracic Anastomosis in view of Anastomotic Leak if it is Thoracic Lesion Hence Cervical anastomosis.
In case of Lower Growth-IvorLewis -Below the level of Azygos.
Yes. The proximal resection margin would vary with the stage of the tumour. For T2 or higher disease, it would be preferable to achieve a proximal resection margin of 10 cms or above.
our practice is to do an Endosono and narrow band imaging ,if it is a Tia mucosal leision subject them for EMR.Otherwise Total esophagectomy with cervical hand sewn or stapled anastamosis ,as it is difficult to assess submucosal proximal microscopic involvement.
It also depends on the location of the tumor; high proximal third tumors or even cervical tumors you often don't have 8 cm.
In my viewpoint, it is better to perform total thoracic esophagectomy for patients with SCC of the esophagus, no matter how long is the proximate resection edge.
Good debate initiated by Dr. Awad.
I agree with Dr. Wang, and it seems the general opinion supports total esophagectomy for patients with SCC (except T1 tumors)
In Japan, where the clinical research on SCC of the esophagus is advanced, it is the standard operation for SCC of the thoracic esophagus to perform total esophagectomy plus at least 2-field lymph node dissection. The survival rate is satisfactory. I think there is something in what they do.
For T1a（mucousal），EMR.
For T1b (submucousal),ESD. If tumor deeper than 1/3 submucousal, total esophagectomy plus 3FLND.
It depends on tumor staging and tumor location. We prefer to perform a sub-total esophagectomy and high intra-thoracic anastomosis even for lower esophageal lesions (for oncologic margin and better functional results). Cervical lesions need a different consideration: try definitive CT-RT first, lower margin possibilities, pharingo-esophagectomy may be needed for very high lesions.
The evidence is contentious, ranging from 5cm - 10cm although the distance has to take into account many factors (oesophagus in situ vs oesophagus ex-vivo vs post fixation). It is also a very difficult clinical question to adjust for because clinical outcomes such as loco-regional anastomtoic recurrence are multifactorial and may relate to tumour stage, grade, lympho-vascular invasion and what ncological therapies the patient received.
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