The development of new sensitive immunohistochemical methods allows the detection of single tumor cells or cell clusters in lymph nodes staged as tumor free on routine histologic examination. The prevalence and prognostic impact of these so-called lymph node 'micrometastases' has been studied in a variety of different tumor types. Only limited and still somewhat conflicting data are available for esophageal carcinoma. A differentiation between 'tumor cell microinvolvement' and true 'micrometastases' may help to clarify these controversies. While lymph node micrometastases are common even in patients with pT1 or pT2 squamous cell esophageal cancer, they appear to occur late in patients with esophageal adenocarcinoma. In contrast, tumor cell microinvolvement of lymph nodes in the absence of micrometastases seems to be more common in patients with adenocarcinoma. Periesophageal inflammation and scarring, due to the underlying chronic gastroesophageal reflux disease in patients with adenocarcinoma of the distal esophagus, may account for the apparent differences in the biology and pattern of lymph node metastases between these two esophageal tumor entities. A prognostic effect, similar to that of frank lymph node metastases, has been convincingly shown for lymph node micrometastases but not for lymph node microinvolvement. Although preliminary, these observations support the use of different strategies in lymphadenectomy for squamous cell and adenocarcinoma of the esophagus.
In general, lymphadenectomy is indicated as a surgical treatment of esophageal carcinoma. It is also proven that lymphadenectomy is necessary for precise tumor staging. Adjuvant and additive therapy are indicated if based on precise staging. Patients with pT1-2 tumors or limited mediastinal and perigastric nodal metastases derived the greatest benefit from lymphadenectomy. In patients with advanced nodal metastases, remarkable reduction of local recurrence can be achieved by adequate lymphadenectomy. The most important prerequisite, however, is an RO-resection (no microscopic and macroscopic residual tumor).
We report a retrospective analysis of 71 patients, operated for primary small bowel tumors (SBT): 47 malignant (66.2%) and 24 benign (33.8%) tumors. Of the malignant tumors, adenocarcinomas predominated (38.3%), followed by neuroendocrine tumors (31.9%), Non-Hodgkin lymphomas (NHL) (12.8%), leiomyosarcomas (10.6%) and other rare entities (6.4%). Morbidity of surgical treatment was 16.9%, 30-day mortality 7%. The estimated 5-year survival rate in malignant lesions was 31.8%. Univariate analysis identified the presence of distant metastasis and the resection status (R status) as prognostic factors (p = 0.034 and p = 0.001). There was no influence of T, N status or grading on survival. A complete macroscopic and microscopic tumor resection has to be the aim of any curative surgical approach in patients with SBT.
