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Eur J Cardiothorac Surg 1999;16:S31-S33
© 1999 Elsevier Science NL

The role of thoracoscopic staging of esophageal cancer patients

Division of Thoracic and Cardiovascular Surgery, University of Maryland Medical School Baltimore, Maryland, USA

^* Corresponding author. University of Maryland, Division of Thoracic and Cardiovascular Surgery, 22 South Greene Street, Rm N4W94, Baltimore, Maryland 21201, USA Tel.: +1-410-328-6366; fax: +1-410-328-0693 (Email: mkrasna{at}surgery1ab.umd.edu).

Introduction: This study was designed to compare thoracoscopy/1aparoscopy (TS/LS) staging with non-invasive clinical staging by CT and EUS for patients with esophageal carcinoma.Methods and results: CT and EUS followed by TS/LS were used to stage 88 patients with EGD proven esophageal carcinoma. Thoracoscopic staging was done in 82 patients and found N₁ in 11 patients. Fifty-four patients had laparoscopy which detected N₁ in 21 patients. Thirty-four cases had chemoradiation followed by surgery. Esophagectomy was performed in 47 patients after thoracoscopic staging and 33 with laparoscopic staging. Of these 47 resected patients, thoracoscopic staging showed N₀ in 42 patients and N₁ in five patients with an accuracy of 93.6%. Laparoscopic staging detected normal celiac lymph nodes in 20 patients and diseased LN in 11 patients with an accuracy of 93.9%. Comparing with final resection pathology, the sensitivity, specificity and positive predictive value of staging for N₁ disease in the chest was 62.5, 100.0 and 100.0% by TS; 75.0, 75.6, and 23.1% by CT and 0.0, 51.4 and 5.5% by EUS, respectively. For N₁ disease in the abdomen it was 84.6, 100.0 and 100.0% by Ls; 0.0, 97.1 and 0.0% by CT and 22.2, 81.5 and 28.6% by EUS, respectively.Conclusion: TS/LS staging of esophageal cancer patients with or without preoperative chemoradiation has a higher specificity and accuracy than CT and EUS, especially for N₁ disease in the chest. It also allows individualization of preoperative radiotherapy fields.

Key Words: Thoracoscopy • Laparoscopy • TNM Staging • Esophageal cancer • CT • EUS