THORACOSCOPIC LYMPH-NODE STAGING FOR ESOPHAGEAL CANCER

Thoracoscopy allows evaluation of the mediastinum and assessment of th e local spread of malignancy. Adjuvant therapy trials have shown some increased survival for esophageal cancer although morbidity is high. P reoperative staging may allow appropriate allocation of adjuvant thera py. Patients with esophageal cancer underwent computed tomographic sca n, magnetic resonance imaging, and endoesophageal ultrasonography. Tho racoscopic staging was performed through the left chest with biopsy of American Thoracic Society level 5 and 6 and 8 and 9 lymph nodes. Rese ction at a separate sitting with complete intraoperative lymph node sa mpling was done. Fourteen patients underwent thoracoscopic lymph node staging. One procedure could not be completed because of adhesions. Of the 13 patients undergoing successful staging, all had correct thorac ic lymph node staging confirmed at surgical exploration. Two patients with adenocarcinoma of the distal third/gastroesophageal junction were found at laparotomy to have positive celiac lymph nodes. Two patients who had lymph nodes positive at computed tomographic scan and magneti c resonance imaging were found to have negative lymph nodes at thoraco scopy and subsequent resection. Two patients were found to have pulmon ary metastasis at thoracoscopy. Lymph node stage in esophageal carcino ma is an important prognostic indicator. Thoracoscopic lymph node stag ing provides accurate pre-resection staging information.