SELECTION OF PATIENTS FOR CURATIVE OR PALLIATIVE RESECTION OF ESOPHAGEAL CANCER BASED ON PREOPERATIVE ENDOSCOPIC ULTRASONOGRAPHY

Objective: To assess the accuracy of pretreatment staging and the pote ntial of using endosonographic findings to select patients for curativ e or palliative resection by comparing the preoperative endosonographi c and computed tomographic (CT) findings with the histology of the sur gical specimen. Methods: Forty-two patients referred to our clinic wit h esophageal carcinoma underwent preoperative upper endoscopy with bio psy, endosonography, thoracic CT, and abdominal CT. Based on endoscopi c ultrasonographic findings, patients with early-stage disease underwe nt enbloc esophagogastrectomy, whereas those with advanced disease had a palliative transhiatal esophagectomy. Exceptions included patients with poor physiologic reserve who were treated by the transhiatal rout e. Results: In eight patients, we were unable to pass the ultrasonogra phic endoscope. Seven of these eight had transmural tumors with nodal involvement on histologic study. Tumor length, based on endosonographi c measurements, was correctly predicted in 34 patients (85%). Extent o f wall penetration was accurately predicted in 26 (76%) of the 34, and regional lymph node status was accurately predicted in 28 (82%) of th e 34. Of the patients with sonographic wall penetration, 80% had histo logic evidence of one or more positive nodes. Using the WNM staging sy stem, endoscopic ultrasonography correctly staged the cancer in 68% of the patients. Three patients were treated with an inappropriate proce dure.Conclusion: Endosonography is a reliable method for the preoperat ive staging and selection of patients for curative or palliative resec tion. Endosonographic wall penetration appears to be a critical factor in determining tumor spread.