Minimally invasive surgical staging for esophageal cancer.
BACKGROUND
The incidence of esophageal adenocarcinoma is increasing in the United States, and the 5-year survival rate is dismal. Preliminary data suggest that conventional imaging is inaccurate in staging esophageal cancer and could limit accurate assessment of new treatments. The objective of this study was to compare minimally invasive surgical staging (MIS) with conventional imaging for staging esophageal cancer.


METHODS
Patients with potentially resectable esophageal cancer were eligible. Staging by conventional methods used computed tomography (CT) scan of the chest and abdomen, and endoscopic ultrasound (EUS), whereas MIS used laparoscopy and videothoracoscopy. Conventional staging results were compared to those from MIS.


RESULTS
In 53 patients, the following stages were assigned by CT scan and EUS: carcinoma in situ (CIS; n = 1), I (n = 1), II (n = 23), III (n = 20), IV (n = 8). In 17 patients (32.1%), MIS demonstrated inaccuracies in the conventional imaging, reassigning a lower stage in 10 patients and a more advanced stage in 7 patients.


CONCLUSIONS
In 32.1% of patients with esophageal cancer, MIS changed the stage originally assigned by CT scan and EUS. Therefore, MIS should be applied to evaluate the accuracy of new noninvasive imaging methods and to assess new therapies for esophageal cancer.
Luketich
J D
JD
Section of Thoracic Surgery and the Minimally Invasive Surgery Center, C-800 Presbyterian University Hospital, 200 Lothrop Street, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Meehan
M
M
Nguyen
N T
NT
Christie
N
N
Weigel
T
T
Yousem
S
S
Keenan
R J
RJ
Schauer
P R
PR
D000230:Adenocarcinoma / Q000473:pathology*; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009367:Neoplasm Staging / Q000379:methods*; D014055:Tomography, Emission-Computed / Q000379:methods; D014057:Tomography, X-Ray Computed; D020535:Video-Assisted Surgery / Q000379:methods