CT ASSESSMENT OF RESECTABILITY PRIOR TO TRANSHIATAL ESOPHAGECTOMY FORESOPHAGEAL GASTROESOPHAGEAL JUNCTION CARCINOMA

The ability of preoperative CT to assess resectability and to stage ca rcinoma of the esophagus and gastroesophageal junction was studied in 71 patients who underwent transhiatal esophagectomy. Patients with pre operatively proven distant metastases who did not have surgery were no t included in the present study. At surgery the tumor invaded adjacent mediastinal or abdominal structures in 18 patients (prevalence 25%), but was nonresectable in only 7 of these 18 patients (39%). Invasions of the tracheobronchial tree, the aorta, and the diaphragm were correc tly detected on CT in 5 of 6, 1 of 2, and 2 of 10 patients. There were four false-positive results on CT; tracheobronchial invasion and peri cardial invasion were incorrectly predicted in one and three patients, respectively. Invasion of adjacent structures was correctly assessed on CT in 58 (82%) patients and the depth of tumor invasion was correct ly determined in 49 (69%) patients. Computed tomography correctly stag ed 57% of patients according to the classification of the American Joi nt Committee on Cancer. Understaging (31%) occurred more often than ov erstaging (11%). In the present study, computed tomography was not eff ective in assessing nonresectability by diagnosing invasion because of the relatively low prevalence of invasion of adjacent structures and the fact that invasion was often not associated with nonresectability. In assessing invasion itself, CT was accurate in diagnosing tracheobr onchial involvement, but was limited in diagnosing invasion of other a djacent structures. In assessing stage grouping, CT was limited in det ecting either diaphragmatic invasion or lymph node involvement.