**3. Results**

There were no complications of EMR/ESD. On histopathological examination, the depth of tumor invasion was sm1 in 22 cases, sm2 in 9, and sm2 EM (+) in 5. Lymphatic invasion (ly) was found in 18 cases (50%), and there was 1 case (3%) of vascular invasion (v).

Sixteen patients were treated with EMR alone, 8 received EMR + chemotherapy, 2 had EMR + radiotherapy, and 10 had EMR + chemoradiotherapy.

Combination Therapy After EMR/ESD for

patient died from the primary disease

100%

80%

60%

**Survival rate**

Fig. 7. Over all survival

40%

20%

0%

submucosal layer.

Esophageal Squamous Cell Carcinoma with Submucosal Invasion 95

Fig. 6. After 6 month later, intrmural metastasia and cervical lymph node were detected. The

method of excising extensive lesions en bloc. Endoscopic resection was previously considered to be curative for tumors limited to the proper mucosal layer9). Although the indications of EMR/ESD have been extended to tumors with invasion of the muscularis mucosae and submucosal tumors with a comparatively low rate of lymph node metastasis in recent years11)-13), these procedures are not indicated for tumors invading deeply into the

0 1 2 3 4 5

(Year)

Fig. 4. 0-IIa+IIc lesion was seen in middle esophagus. EMR was performed

Fig. 5. Though pathological finding showed moderate. SCC, pSM1, ly3, v0, chemoradiotherapy was treated

Recurrence was diagnosed in three patients. Medistinal lymph node recurrence occurred in a man with moderately differentiated SCC (sm1, ly (-)) treated by EMR alone and cervical lymph node recurrence was detected in 1 woman with moderately differentiated SCC (sm2, ly (+)) treated by EMR alone. Both cervical lymph node recurrence and intramural metastasis were detected in 1 man with moderately differentiated SCC (sm1, ly (+)) treated by EMR + chemoradiotherapy (Fig. 4-6). Local recurrence did not occur.

There was 1 death from the primary disease and 10 patients died of other diseases. The overall survival rate was 69% (Fig. 7).
