COMBINED THORACOSCOPIC LAPAROSCOPIC STAGING OF ESOPHAGEAL CANCER/

Unlike mediastinoscopy in lung cancer, there exists no standard minima lly invasive test to stage esophageal cancer, If it were possible to o btain exact preoperative staging in esophageal cancer, patients could be separated prospectively to receive neoadjuvant therapy appropriatel y, We studied the feasibility and efficacy of thoracoscopic and laparo scopic lymph node staging in esophageal cancer. Thoracoscopic staging was performed in 45 patients with biopsy-proven carcinoma of the esoph agus. Laparoscopic staging was done in the last 19 patients, Thoracosc opic staging was aborted in three patients because of adhesions. Thora cic lymph node stage was NO in 39 patients and N1 in three; celiac lym ph nodes were normal in 13 and diseased in six. Esophageal resection w as performed in 30 patients after thoracoscopic staging; 17 of these u nderwent laparoscopic staging. Thoracoscopic staging showed NO lymph n ode status in 28 patients and N1 in two patients, Two of the 28 patien ts (7%) with ND disease were found at resection to have paraesophageal lymph node involvement (N1); thus the disease was understaged by thor acoscopic staging. Thoracoscopic staging was accurate in detecting the presence of diseased thoracic lymph nodes in 28 of 30 cases (93%). La paroscopic staging detected normal celiac nodes in 12 patients and dis eased lymph nodes in five patients, After esophagectomy, the final pat hology report in the 12 patients with NO disease was NO in 11 and dise ased lymph nodes in one patient. Thus laparoscopic staging was accurat e in detecting lymph node metastases in 16 of 17 patients (94%). Thora coscopic and laparoscopic staging are more accurate than existing stag ing methods. Six of 19 patients in whom laparoscopic staging was used had unsuspected celiac axis lymph node involvement that had been misse d by standard noninvasive techniques. One of three patients with thora cic lymph nodes and three of six with celiac lymph nodes were down-sta ged after preoperative chemotherapy/radiotherapy. The role of thoracos copy and laparoscopy in staging esophageal cancer should be further ev aluated in a multiinstitutional trial.