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Staging of squamous esophageal cancer: Accuracy and value

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Abstract

Endoscopic ultrasonography (EUS) and computed tomography (CT) should be used as complementary methods for TNM staging of esophageal cancer. EUS is the most accurate modality for staging primary tumor and mediastinal lymph node metastases. CT should be used to detect infiltration of other mediastinal organs and distant metastases. For esophageal cancer staging magnetic resonance imaging (MRI) is not superior to CT. For detection of cervical lymph node metastases percutaneous ultrasonography is appropriate. In patients with advanced distal carcinoma of the esophagus, hepatic and peritoneal metastases and intraabdominal lymph node infiltration should be ruled out by laparos-copy prior to surgery. The results of preoperative staging are relevant if the management of esophageal cancer comprises not only surgery but also endoscopic mucosectomy, primary palliative procedures, and especially neoadjuvant radiochemotherapy. Within therapeutic trials the precise staging prior to treatment is essential for analysis of the results. The value of routine postoperative staging during a follow-up program is yet unproved for esophageal cancer.

Résumé

L'échoendoscopie (EES) et la tomodensitométrie (TDM) devraient être utilisées comme moyens complémentaires de l'évaluation dans la classification TMN du cancer de l'oesophage. L'EES est la modalité la plus précise pour déterminer le stade de la tumeur primitive et l'existence des métastases ganglionnaires médiastinales. La TDM doit être utilisée pour détecter l'infltration des autres structures médiastinales et l'existence de métastases à distance. La résonance magnétique n'est pas supérieure à la TDM pour le bilan du cancer de l'oesophage.

L'ESS est très efficace dans la détection des métastases cervicales. La présence de métastases hépatiques, ganglionnaires abdominales, et/ou péritonéales doit être éliminée par la laparoscopie préopératoire à visée diagnostique.

Les résultats de la classification préopératoire sont importants lorsqu'on considère l'ensemble des traitements qui comprend globalement la mucosectomie endoscopique, les procedés palliatifs et surtout la radio-chimiothérapie néoadjuvante. La classification correcte est capitale pour l'entrée des malades dans les essais thérapeutiques. La valeur du bilan postopératoire systématique n'a pas encore été démontrée.

Resumen

La estadificaión del cáncer esofágico es importante para juzgar la resectabilidad del tumor y para evaluar el pronóstico del paciente. La relevancia del resultado de la estadificación preoperatoria depende de cual haya sido la estrategia utilizada para el manejo del cáncer esofégico. La ultrasonografía endoscópica (USE) y la tomografía computadorizada (TC) deben ser utilizadas como métodos complementarios para la estadificación TNM del cáncer del esófago. La USE es la modalidad más certera para estadificar el tumor primario y las metástasis ganglionares mediastinales. La TC debe ser usada para la detección de metástasis en otros órganos mediastinales y en ubicaciones distantes. En la actualidad la resonancia magnética no es un método superior, en cuanto a estadificación, a la TC.

Para la detección de metástasis en los ganglios cervicales la ultrasonografía percutánea es una técnica muy apropiada. En casos de carcinoma avanzado del esófago distal deben utilizarse la laparoscopia preoperatoria para excluir la presencia metástasis hepáticas y perìtoneales, así como de infiltración tumoral de ganglios linfáticos abdominales.

Los resultados de la estadificación preoperatoria tienen pertinencia si el manejo del cáncer esofágico comprende no sólo la cirugía, sino también la mucosectomía endoscópica, procedimientos paliativos primarios y, especialmente, la radio/quimioterapia neoadyuvante. En los ensayos clínicos terapéuticos es esencial disponer de una estadificación precisa antes de iniciar tratamiento para el análisis de los resultados. En la actualidad no está comprobado el papel de la estadificación postoperatoria como rutina en el curso de un programa de seguimiento.

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  1. Department of Surgery, Technische Universität München, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675, Munich, Germany

    Arnulf H. Hölscher M.D., Hans Joachim Dittler M.D. & J. Rüdiger Siewert M.D.

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Hölscher, A.H., Dittler, H.J. & Siewert, J.R. Staging of squamous esophageal cancer: Accuracy and value. World J. Surg. 18, 312–320 (1994). https://doi.org/10.1007/BF00316809

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