Bronchoscopic staging of squamous cell carcinoma of the upper thoracic esophagus

Objective: To identify bronchoscopic findings that predict resectability of squamous cell carcinoma of the upper thoracic esophagus. Design: Tracheobronchoscopy was performed in patients with squamous cell ca rcinoma of the thoracic esophagus to assess the infiltration of the tracheo bronchial tree by the tumor and predict the resectability. Bronchoscopic re cords were matched with clinical outcome and intraoperative findings. Setting: University hospital, tertiary care referral center. Patients: A total of 113 patients with supracarinal esophageal carcinoma un derwent bronchoscopy as part of the preoperative staging. In 47 patients th e bronchoscopy was repeated after a regimen of neoadjuvant chemotherapy. Intervention: A total of 160 bronchoscopies performed by the same operator. Main Outcome Measures: Bronchoscopic records matched with clinical outcome and intraoperative findings. Results: Including patients before and after neoadjuvant chemotherapy, 27 o f the 40 with no bronchoscopic abnormalities were operated on: in 24 (89%) of them radical surgical resection was possible. Among the 22 patients with a slight compression on the tracheobronchial tree admitted to surgery, a r adical surgical resection was possible in 20 cases (91%). In none of the 5 patients with compression/deviation associated with fixation of the tracheo bronchial tree but no mucosal infiltration who underwent surgery was a radi cal surgical resection possible because of tracheobronchial infiltration. Conclusions: Compression of the tracheobronchial tree does not necessarily mean infiltration by esophageal carcinoma.. If the compression is slight an d the mobility of the tracheobronchial tree is normal, a radical esophagect omy is possible in 91%, of patients.