The role of thoracoscopic staging of esophageal cancer patients

Introduction: This study was designed to compare thoracoscopy/laparoscopy ( TS/LS) staging with non-invasive clinical staging by CT and EUS for patient s with esophageal carcinoma. Methods and results: CT and EUS followed by TS /LS were used to stage 88 patients with EGD proven esophageal carcinoma. Th oracoscopic staging was done in 82 patients and found N-1 in 11 patients. F ifty-four patients had laparoscopy which detected N-1 in 21 patients. Thirt y-four cases had chemoradiation followed by surgery. Esophagectomy was perf ormed in 47 patients after thoracoscopic staging and 33 with laparoscopic s taging. Of these 47 resected patients, thoracoscopic staging showed N-0 in 42 patients and N-1 in five patients with an accuracy of 93.6%. Laparoscopi c staging detected normal celiac lymph nodes in 20 patients and diseased LN in 11 patients with an accuracy of 93.9%. Comparing with final resection p athology, the sensitivity, specificity and positive predictive Value of sta ging for N-1 disease in the chest was 62.5, 100.0 and 100.0% by TS; 75.0, 7 5.6, and 23.1% by CT and 0.0, 51.4 and 5.5% by EUS, respectively. For N-1 d isease in the abdomen it was 84.6, 100.0 and 100.0% by Ls; 0.0, 97.1 and 0. 0% by CT and 22.2, 81.5 and 28.6% by EUS, respectively. Conclusion: TS/LS s taging of esophageal cancer patients with or without preoperative chemoradi ation has a higher specificity and accuracy than CT and EUS, especially for N-1 disease in the chest. It also allows individualization of preoperative radiotherapy fields. (C) 1999 Elsevier Science B.V. All rights reserved.