ADVANCES IN STAGING OF ESOPHAGEAL-CARCINOMA

Staging criteria for thoracic malignancies are based on survival group ings that allow the stage groups to be used as prognosticators for can cer treatment. Definitive staging of esophageal cancer facilitates all ocation of patients to appropriate treatment regimens according to eac h patient's stage. Existing noninvasive staging methods are imperfect in detecting abdominal and thoracic lymph node metastases in patients with esophageal cancer. Thoracoscopy is an excellent means for staging the chest and mediastinum. We have used thoracoscopic lymph node stag ing and laparoscopic lymph node staging for esophageal cancer since 19 92. Thoracoscopy was performed in 45 patients with biopsy specimen-pro ved carcinoma of the esophagus. Laparoscopy was done in the last 20 pa tients. Laparoscopic-assisted feeding jejunostomies were performed in patients with obstructive symptoms. Directed liver biopsies were perfo rmed if lesions were present. Thoracoscopy was aborted in three patien ts because of adhesions. Thoracic lymph node stage was NO in 40 patien ts and N1 in 3. Celiac lymph nodes were normal in 14 patients and abno rmal in 6. Esophageal resection was performed in 30 patients after tho racoscopic lymph node staging; 18 of these underwent laparoscopic lymp h node staging. Thoracoscopic staging showed NO lymph node status in 2 8 patients and N1 in 2. Two of these N0 patients (7%) were found at re section to have paraesophageal lymph involvement (N1). Thoracoscopic l ymph node staging was accurate in detecting the status of thoracic lym ph nodes in 28 of 30 cases (93%). Laparoscopic staging found normal ce liac nodes in 13 patients and abnormal lymph nodes in 5. After esophag ectomy, final pathologic finding of the 13 N0 patients was N0 in 12 pa tients and N1 in 1 patient. Thus, laparoscopic lymph node staging was accurate in detecting lymph node status in 17 of 18 patients (94%). Si x of 20 patients undergoing laparoscopy had unsuspected celiac axis ly mph node involvement missed by standard noninvasive techniques. Three percent of thoracic lymph nodes and 17% of celiac lymph nodes were dow nstaged after preoperative chemoradiotherapy. Thoracoscopic and laparo scopic lymph node staging are more accurate than existing staging meth ods.