title: Thoracoscopic and laparoscopic lymph node staging in esophageal cancer: do clinicopathological factors affect the outcome?
abstract: BACKGROUND
  This study was performed to evaluate the pattern of lymphatic metastases found by combined thoracoscopic (TS) and laparoscopic (LS) lymph node staging in esophageal cancer, and ascertain whether clinicopathologic factors may be used to guide the clinical practice of combined TS and LS staging.
  
  
  METHODS
  A retrospective study was performed in a series of 76 esophageal cancer patients who had undergone both TS and LS staging before treatment. The correlation of TS and LS lymph node metastases with clinicopathologic factors was analyzed, including the clinical T stage, clinical N stage, tumor location, and histology.
  
  
  RESULTS
  Thirty-one patients (40.8%) were found to have lymphatic metastasis by TS and LS staging. Among them, 22 patients had abdominal lymph node metastases, 7 patients had mediastinal lymph node metastases, and 2 patients had both. Patients with advanced T stage (T3 to T4) or adenocarcinoma had a higher frequency of abdominal lymphatic metastases than patients with early T stage (T1 to T2) (39% vs 16%; p = 0.04) or squamous cell carcinoma (39% vs 20%; p = 0.079), respectively. Patients with clinical abdominal N1 stage had a higher incidence of positive laparoscopic finding than patients with clinical abdominal N0 stage (67% vs 23%; p = 0.001). There was no significant correlation between lymphatic metastases and the location of the primary tumor.
  
  
  CONCLUSIONS
  Clinicopathologic factors, including the histologic type, the clinical T stage, and abdominal N stage, may affect the outcome of TS and LS lymph node staging in esophageal cancer patients. This clinicopathologic impact may play a role for the selection of candidates for TS and LS staging, and also allows surgeons to focus their attention on the most likely high-yield biopsy targets.
authors.affiliation: Division of Thoracic Surgery, University of Maryland Medical System, Baltimore 21201, USA. mkrasna@smail.umaryland.edu
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Krasna
authors.forename: Xiaolong
authors.initials: X
authors.lastname: Jiao
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Sonett
authors.forename: Ziv
authors.initials: Z
authors.lastname: Gamliel
authors.forename: Afshin
authors.initials: A
authors.lastname: Eslami
authors.forename: Yael
authors.initials: Y
authors.lastname: Raefaly
authors.forename: Yousheng
authors.initials: Y
authors.lastname: Mao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013906:Thoracoscopy; D016896:Treatment Outcome