The role of staging investigations for oesophago-gastric carcinoma.
OBJECTIVE
To study the frequency with which unresectable disease was identified on pre-operative staging investigations in patients with oesophago-gastric carcinoma, and to audit whether a staging protocol had reduced the rate of exploratory surgery.


METHODS
Ninety-eight patients with oesophageal carcinoma, 89 patients with adenocarcinoma of the gastro-oesophageal junction (GOJ) and 68 patients with gastric carcinoma were staged according to a protocol of computerised tomography, laparoscopy and endoscopic ultrasound.


RESULTS
The frequency with which each investigation identified unresectable disease was as follows: (a) computerised tomography-oesophagus 12/67, GOJ 13/58, stomach 10/60; (b) laparoscopy-oesophagus 3/22, GOJ 5/45, stomach 8/23; and (c) endoscopic ultrasound-oesophagus 15/55, GOJ 3/30. By tumour location, rates of exploratory surgery were 1/18 for the oesophagus, 12/35 for the GOJ and 4/42 for the stomach. All of the staging failures in patients with GOJ carcinomas related to posterior tumour extension into the lesser sac.


CONCLUSIONS
Staging investigations precluded resection in one-third of patients, the greatest yield being for laparoscopy in gastric carcinoma. In spite of this, 18% of patients undergoing surgical intervention underwent exploratory surgery alone, notably patients with GOJ carcinoma.
Clements
D M
DM
Department of Surgery, Royal Glamorgan Hospital, Llantrisant, Rhondda-Cynon-Taff CF72 8XR, UK.
Bowrey
D J
DJ
Havard
T J
TJ
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D002985:Clinical Protocols; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy; D004943:Esophagogastric Junction; D005260:Female; D005743:Gastrectomy; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome