Skip to main content

Advertisement

SpringerLink
Log in

Combined pretherapeutic endoscopic and laparoscopic ultrasonography may predict survival of patients with upper gastrointestinal tract cancer

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The combination of endoscopic and laparoscopic ultrasonography (EUS–LUS) is accurate for resectability assessment of patients with upper gastrointestinal cancer (UGIC). But neither the ability of EUS/LUS to predict long-term prognosis nor the potential impact on patient survival using this selection strategy has been investigated. This prospective, single-center study evaluated whether pretherapeutic EUS–LUS stratification related to the prognosis in UGIC patients and whether patient selection by this strategy provided a prognostic outcome comparable with survival data from the literature.

Methods

Each patient had a pretherapeutic tumor node metastasis (TNM) stage and a resectability assessment assigned based on EUS–LUS findings. Survival curves were constructed and compared for each of the EUS–LUS TNM stage and resectability groups at the end of the observation period. Finally, the R0 resection rate, median, and 5-year survival rates were compared with the literature.

Results

This study enrolled 936 consecutive patients with esophageal (n = 256), gastric (n = 273), or pancreatic (n = 407) cancer. A statistically significant survival difference (p < 0.01) between the different TNM stages and resectability groups predicted by EUS–LUS was observed regardless of the cancer type. The poor prognosis for the patients with irresectable or disseminated UGIC was accurately predicted by EUS and LUS. The R0 resection rate as well as the median and 5-year survival rates were comparable with data from the literature.

Conclusion

The pretherapeutic EUS–LUS patient stratification related significantly to the final prognosis for UGIC patients. An EUS–LUS-based patient selection strategy seemed to provide a prognostic outcome similar to data from computed tomography (CT)-based populations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Mariette C, Balon JM, Maunoury V, Taillier G, Van SI, Triboulet JP (2003) Value of endoscopic ultrasonography as a predictor of long-term survival in oesophageal carcinoma. Br J Surg 90:1367–1372

    Article  PubMed  CAS  Google Scholar 

  2. Pfau PR, Ginsberg GG, Lew RJ, Brensinger CM, Kochman ML (2001) EUS predictors of long-term survival in esophageal carcinoma. Gastrointest Endosc 53:463–469

    Article  PubMed  CAS  Google Scholar 

  3. Hiele M, De LP, Schurmans P, Lerut A, Huys S, Geboes K, Gevers AM, Rutgeerts P (1997) Relation between endoscopic ultrasound findings and outcome of patients with tumors of the esophagus or esophagogastric junction. Gastrointest Endosc 45:381–386

    Article  PubMed  CAS  Google Scholar 

  4. Natsugoe S, Yoshinaka H, Shimada M, Sakamoto F, Morinaga T, Nakano S, Kusano C, Baba M, Takao S, Aikou T (2001) Number of lymph node metastases determined by presurgical ultrasound and endoscopic ultrasound is related to prognosis in patients with esophageal carcinoma. Ann Surg 234:613–618

    Article  PubMed  CAS  Google Scholar 

  5. Bentrem D, Gerdes H, Tang L, Brennan M, Coit D (2007) Clinical correlation of endoscopic ultrasonography with pathologic stage and outcome in patients undergoing curative resection for gastric cancer. Ann Surg Oncol 14:1853–1859

    Article  PubMed  Google Scholar 

  6. Rizk NP, Venkatraman E, Bains MS, Park B, Flores R, Tang L, Ilson DH, Minsky BD, Rusch VW (2007) American Joint Committee on Cancer staging system does not accurately predict survival in patients receiving multimodality therapy for esophageal adenocarcinoma. J Clin Oncol 25:507–512

    Article  PubMed  Google Scholar 

  7. Nio Y, Yamasawa K, Yamaguchi K, Itakura M, Omori H, Koike M, Kitamura Y, Tsuji M, Endo S, Ogo Y, Yano S, Sumi S (2003) Problems in the N-classification of the new 1997 UICC TNM stage classification for gastric cancer: an analysis of over 10 years’ outcome of Japanese patients. Anticancer Res 23:697–705

    PubMed  Google Scholar 

  8. Hermanek P, Hutter RV, Sobin LH, Wittekind C (1999) International Union Against Cancer: classification of isolated tumor cells and micrometastasis. Cancer 86:2668–2673

    Article  PubMed  CAS  Google Scholar 

  9. Merkel S, Mansmann U, Meyer T, Papadopoulos T, Hohenberger W, Hermanek P (2004) Confusion by frequent changes in staging of exocrine pancreatic carcinoma. Pancreas 29:171–178

    Article  PubMed  Google Scholar 

  10. Wittekind C, Compton CC, Greene FL, Sobin LH (2002) TNM residual tumor classification revisited. Cancer 94:2511–2516

    Article  PubMed  Google Scholar 

  11. Kaushik N, Khalid A, Brody D, McGrath K (2006) EUS-guided paracentesis for the diagnosis of malignant ascites. Gastrointest Endosc 64:908–913

    Article  PubMed  Google Scholar 

  12. Mortensen MB, Pless T, Durup J, Ainsworth AP, Plagborg GJ, Hovendal C (2001) Clinical impact of endoscopic ultrasound-guided fine-needle aspiration biopsy in patients with upper gastrointestinal tract malignancies: a prospective study. Endoscopy 33:478–483

    Article  PubMed  CAS  Google Scholar 

  13. Mortensen MB, Fristrup CW, Ainsworth AP, Pless T, Nielsen HO, Hovendal C (2006) Combined preoperative endoscopic and laparoscopic ultrasonography for prediction of R0 resection in upper gastrointestinal tract cancer. Br J Surg 93:720–725

    Article  PubMed  CAS  Google Scholar 

  14. Lordick F, Ott K, Krause BJ, Weber WA, Becker K, Stein HJ, Lorenzen S, Schuster T, Wieder H, Herrmann K, Bredenkamp R, Hofler H, Fink U, Peschel C, Schwaiger M, Siewert JR (2007) PET to assess early metabolic response and to guide treatment of adenocarcinoma of the oesophagogastric junction: the MUNICON phase II trial. Lancet Oncol 8:797–805

    Article  PubMed  Google Scholar 

  15. Chen J, Xu R, Hunt GC, Krinsky ML, Savides TJ (2006) Influence of the number of malignant regional lymph nodes detected by endoscopic ultrasonography on survival stratification in esophageal adenocarcinoma. Clin Gastroenterol Hepatol 4:573–579

    Article  PubMed  Google Scholar 

  16. Eloubeidi MA, Wallace MB, Hoffman BJ, Leveen MB, Van VA, Hawes RH, Reed CE (2001) Predictors of survival for esophageal cancer patients with and without celiac axis lymphadenopathy: impact of staging endosonography. Ann Thorac Surg 72:212–219

    Article  PubMed  CAS  Google Scholar 

  17. Fockens P, Kisman K, Merkus MP, van Lanschot JJ, Obertop H, Tytgat GN (1998) The prognosis of esophageal carcinoma staged irresectable (T4) by endosonography. J Am Coll Surg 186:17–23

    Article  PubMed  CAS  Google Scholar 

  18. Barbour AP, Rizk NP, Gerdes H, Bains MS, Rusch VW, Brennan MF, Coit DG (2007) Endoscopic ultrasound predicts outcomes for patients with adenocarcinoma of the gastroesophageal junction. J Am Coll Surg 205:593–601

    Article  PubMed  Google Scholar 

  19. Anderson DN, Campbell S, Park KG (1996) Accuracy of laparoscopic ultrasonography in the staging of upper gastrointestinal malignancy. Br J Surg 83:1424–1428

    Article  PubMed  CAS  Google Scholar 

  20. Finch MD, John TG, Garden OJ, Allan PL, Paterson-Brown S (1997) Laparoscopic ultrasonography for staging gastroesophageal cancer. Surgery 121:10–17

    Article  PubMed  CAS  Google Scholar 

  21. Flett ME, Lim MN, Bruce D, Campbell SH, Park KG (2001) Prognostic value of laparoscopic ultrasound in patients with gastroesophageal cancer. Dis Esophagus 14:223–226

    Article  PubMed  CAS  Google Scholar 

  22. Das A, Chak A, Sivak MV Jr, Payes J, Cooper GS (2006) Endoscopic ultrasonography and prognosis of esophageal cancer. Clin Gastroenterol Hepatol 4:695–700

    Article  PubMed  Google Scholar 

  23. Harewood GC, Kumar KS (2004) Assessment of clinical impact of endoscopic ultrasound on esophageal cancer. J Gastroenterol Hepatol 19:433–439

    Article  PubMed  Google Scholar 

  24. Schrager JJ, Tarpley JL, Smalley WE, Austin MT, Pearson AS (2005) Endoscopic ultrasound: impact on survival in patients with esophageal cancer. Am J Surg 190:682–686

    Article  PubMed  Google Scholar 

  25. Chak A, Canto M, Gerdes H, Lightdale CJ, Hawes RH, Wiersema MJ, Kallimanis G, Tio TL, Rice TW, Boyce HW Jr (1995) Prognosis of esophageal cancers preoperatively staged to be locally invasive (T4) by endoscopic ultrasound (EUS): a multicenter retrospective cohort study. Gastrointest Endosc 42:501–506

    Article  PubMed  CAS  Google Scholar 

  26. Mariette C, Piessen G, Triboulet JP (2007) Therapeutic strategies in oesophageal carcinoma: role of surgery and other modalities. Lancet Oncol 8:545–553

    Article  PubMed  Google Scholar 

  27. Pye JK, Crumplin MK, Charles J, Kerwat R, Foster ME, Biffin A (2001) One-year survey of carcinoma of the oesophagus and stomach in Wales. Br J Surg 88:278–285

    Article  PubMed  CAS  Google Scholar 

  28. Daly JM, Fry WA, Little AG, Winchester DP, McKee RF, Stewart AK, Fremgen AM (2000) Esophageal cancer: results of an American College of Surgeons Patient Care Evaluation Study. J Am Coll Surg 190:562–572

    Article  PubMed  CAS  Google Scholar 

  29. Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, van EP, Obertop H, Gouma DJ, Taat CW (1995) Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 345:745–748

    Article  PubMed  CAS  Google Scholar 

  30. Degiuli M, Sasako M, Ponti A, Calvo F (2004) Survival results of a multicentre phase II study to evaluate D2 gastrectomy for gastric cancer. Br J Cancer 90:1727–1732

    PubMed  CAS  Google Scholar 

  31. Martin RC, Jaques DP, Brennan MF, Karpeh M (2002) Extended local resection for advanced gastric cancer: increased survival versus increased morbidity. Ann Surg 236:159–165

    Article  PubMed  Google Scholar 

  32. Siewert JR, Bottcher K, Stein HJ, Roder JD (1998) Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg 228:449–461

    Article  PubMed  CAS  Google Scholar 

  33. Danielson H, Kokkola A, Kiviluoto T, Siren J, Louhimo J, Kivilaakso E, Puolakkainen P (2007) Clinical outcome after D1 vs D2–3 gastrectomy for treatment of gastric cancer. Scand J Surg 96:35–40

    PubMed  CAS  Google Scholar 

  34. Lewis WG, Edwards P, Barry JD, Khan S, Dhariwal D, Hodzovic I, Allison MC, Shute K (2002) D2 or not D2? The gastrectomy question. Gastric Cancer 5:29–34

    Article  PubMed  Google Scholar 

  35. Conlon KC, Klimstra DS, Brennan MF (1996) Long-term survival after curative resection for pancreatic ductal adenocarcinoma: clinicopathologic analysis of 5-year survivors. Ann Surg 223:273–279

    Article  PubMed  CAS  Google Scholar 

  36. Beger HG, Rau B, Gansauge F, Poch B, Link KH (2003) Treatment of pancreatic cancer: challenge of the facts. World J Surg 27:1075–1084

    Article  PubMed  Google Scholar 

  37. Shaib Y, Davila J, Naumann C, El-Serag H (2007) The impact of curative intent surgery on the survival of pancreatic cancer patients: a U.S. population-based study. Am J Gastroenterol 102:1377–1382

    Article  PubMed  Google Scholar 

  38. Orringer MB, Marshall B, Iannettoni MD (1999) Transhiatal esophagectomy: clinical experience and refinements. Ann Surg 230:392–400

    Article  PubMed  CAS  Google Scholar 

  39. Swanson SJ, Batirel HF, Bueno R, Jaklitsch MT, Lukanich JM, Allred E, Mentzer SJ, Sugarbaker DJ (2001) Transthoracic esophagectomy with radical mediastinal and abdominal lymph node dissection and cervical esophagogastrostomy for esophageal carcinoma. Ann Thorac Surg 72:1918–1924

    Article  PubMed  CAS  Google Scholar 

  40. Visbal AL, Allen MS, Miller DL, Deschamps C, Trastek VF, Pairolero PC (2001) Ivor Lewis esophagogastrectomy for esophageal cancer. Ann Thorac Surg 71:1803–1808

    Article  PubMed  CAS  Google Scholar 

  41. Hofstetter W, Swisher SG, Correa AM, Hess K, Putnam JB Jr, Ajani JA, Dolormente M, Francisco R, Komaki RR, Lara A, Martin F, Rice DC, Sarabia AJ, Smythe WR, Vaporciyan AA, Walsh GL, Roth JA (2002) Treatment outcomes of resected esophageal cancer. Ann Surg 236:376–384

    Article  PubMed  Google Scholar 

  42. Law S, Kwong DL, Kwok KF, Wong KH, Chu KM, Sham JS, Wong J (2003) Improvement in treatment results and long-term survival of patients with esophageal cancer: impact of chemoradiation and change in treatment strategy. Ann Surg 238:339–347

    PubMed  Google Scholar 

  43. Mariette C, Taillier G, Van Seuningen I, Triboulet JP (2004) Factors affecting postoperative course and survival after en bloc resection for esophageal carcinoma. Ann Thorac Surg 78:1177–1183

    Article  PubMed  Google Scholar 

  44. Alexiou C, Khan OA, Black E, Field ML, Onyeaka P, Beggs L, Duffy JP, Beggs DF (2006) Survival after esophageal resection for carcinoma: the importance of the histologic cell type. Ann Thorac Surg 82:1073–1077

    Article  PubMed  Google Scholar 

  45. Ruol A, Castoro C, Portale G, Cavallin F, Sileni VC, Cagol M, Alfieri R, Corti L, Boso C, Zaninotto G, Peracchia A, Ancona E (2009) Trends in management and prognosis for esophageal cancer surgery: twenty-five years of experience at a single institution. Arch Surg 144:247–254

    Article  PubMed  Google Scholar 

  46. Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, Sydes M, Fayers P (1999) Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Cooperative Group. Br J Cancer 79:1522–1530

    Article  PubMed  CAS  Google Scholar 

  47. Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJ, Welvaart K, Songun I, Meyer S, Plukker JT, van Elk P, Obertop H, Gouma DJ, van Lanschot JJ, Taat CW, de Graaf PW, von Meyenfeldt MF, Tilanus H (1999) Extended lymph-node dissection for gastric cancer. N Engl J Med 340:908–914

    Article  PubMed  CAS  Google Scholar 

  48. Sohn TA, Yeo CJ, Cameron JL, Koniaris L, Kaushal S, Abrams RA, Sauter PK, Coleman J, Hruban RH, Lillemoe KD (2000) Resected adenocarcinoma of the pancreas—616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg 4:567–579

    Article  PubMed  CAS  Google Scholar 

  49. Neoptolemos JP, Dunn JA, Stocken DD, Almond J, Link K, Beger H, Bassi C, Falconi M, Pederzoli P, Dervenis C, Fernandez-Cruz L, Lacaine F, Pap A, Spooner D, Kerr DJ, Friess H, Buchler MW (2001) Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial. Lancet 358:1576–1585

    Article  PubMed  CAS  Google Scholar 

  50. Lim JE, Chien MW, Earle CC (2003) Prognostic factors following curative resection for pancreatic adenocarcinoma: a population-based, linked database analysis of 396 patients. Ann Surg 237:74–85

    Article  PubMed  Google Scholar 

  51. Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Buchler MW (2004) Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg 91:586–594

    Article  PubMed  CAS  Google Scholar 

  52. Schnelldorfer T, Ware AL, Sarr MG, Smyrk TC, Zhang L, Qin R, Gullerud RE, Donohue JH, Nagorney DM, Farnell MB (2008) Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Ann Surg 247:456–462

    Article  PubMed  Google Scholar 

Download references

Disclosures

Michael Bau Mortensen, Claus Fristrup, Alan Ainsworth, Henning Overgaard Nielsen, Torsten Pless, and Claus Hovendal have no conflicts or interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, Odense University Hospital, 5000, Odense C, Denmark

    Michael Bau Mortensen, Claus Fristrup, Alan Ainsworth, Henning Overgaard Nielsen, Torsten Pless & Claus Hovendal

Authors
  1. Michael Bau Mortensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Claus Fristrup
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alan Ainsworth
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Henning Overgaard Nielsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Torsten Pless
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Claus Hovendal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael Bau Mortensen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mortensen, M.B., Fristrup, C., Ainsworth, A. et al. Combined pretherapeutic endoscopic and laparoscopic ultrasonography may predict survival of patients with upper gastrointestinal tract cancer. Surg Endosc 25, 804–812 (2011). https://doi.org/10.1007/s00464-010-1258-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-010-1258-9

Keywords

Search

Navigation