Regarding squamous cell carcinoma of the oesophagus, which statement correctly describes its local spread and its implication for surgery?

• A Spread is circumferential first, so wide radial margins determine resection length
• B The muscularis propria acts as a barrier, so submucosal spread occurs only in T4 tumours
• C Longitudinal spread is limited to 1 cm, allowing short segmental resections
• D Submucosal lymphatics allow extensive longitudinal spread, often requiring total oesophagectomy ✓

Explanation

The oesophagus lacks a serosa and contains a rich longitudinal network of submucosal lymphatics, so tumour cells skip widely up and down the wall beyond the visible margin. This is why curative surgery demands generous proximal and distal clearance, frequently total oesophagectomy with gastric pull-up, rather than segmental resection. Circumferential depth determines T stage, not resection length, and submucosal spread occurs early, not late.

Reference: Shackelford's Surgery of the Alimentary Tract, 8th ed.

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