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Positron emission tomography with F-18-fluorodeoxyglucose in a combined staging strategy of esophageal cancer prevents unnecessary surgical explorations

  • Published:
Journal of Gastrointestinal Surgery

Abstract

Distant metastases or local invasion are frequently found during the explorative phase of surgery for esophageal cancer. This study was performed to determine the rate of patients with incurable disease encountered during exploration and to examine the impact of preoperative staging, including positron emission tomography (PET), on the number of unnecessary explorations. The records of 203 patients with esophageal cancer who were eligible for curative resection were retrospectively reviewed. The surgical reports were analyzed to obtain the reasons for abandoning resection. Furthermore, the different staging modalities according to the related time interval were reviewed for each patient to analyze the influence of them on the number of explorations. After exploratory surgery, resection was abandoned in 78 of the 203 patients (38%) because of distant metastases (n = 59; 29%), metastatic spread and local irresectability (n = 5; 2%), and local irresectability (n = 14; 7%). In a logistic regression model with all preoperative staging modalities and the year of examination as independent variables, F-18-fluorodeoxyglucose (FDG)-PET) was the only modality that predicts intended curative resection in these patients (P < 0.001). In patients with esophageal cancer who are suitable for potentially curative surgery, resection was abandoned mainly because of distant metastases encountered during exploration. The addition of FDG-PET may have reduced the rate of unnecessary surgery in this group of patients.

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References

  1. Hulscher JB, Tijssen JG, Obertop H, van Lanschot JJ. Transthoracic versus transhiatal resection for carcinoma of the esophagus: A meta-analysis. Ann Thorac Surg 2001;72:306–313.

    Article  PubMed  CAS  Google Scholar 

  2. Sihvo EI, Pentikainen T, Luostarinen ME, Ramo OJ, Salo JA. Inoperable adenocarcinoma of the oesophagogastric junction: A comparative clinical study of laser coagulation versus self-expanding metallic stents with special reference to cost analysis. Eur J Surg Oncol 2002;28:711–715.

    Article  PubMed  CAS  Google Scholar 

  3. Ellis FH Jr, Heatley GJ, Krasna MJ, Williamson WA, Balogh K. Esophagogastrectomy for carcinoma of the esophagus and cardia: A comparison of findings and results after standard resection in three consecutive eight-year intervals with improved staging criteria. J Thorac Cardiovasc Surg 1997;113:836–846.

    Article  PubMed  Google Scholar 

  4. Hulscher JB, Nieveen van Dijkum EJ, de Wit LT, et al. Laparoscopy and laparoscopic ultrasonography in staging carcinoma of the gastric cardia. Eur J Surg 2000;166:862–865.

    Article  PubMed  CAS  Google Scholar 

  5. Menon KV, Dehn TC. Multiport staging laparoscopy in esophageal and cardiac carcinoma. Dis Esophagus 2003;16:295–300.

    Article  PubMed  CAS  Google Scholar 

  6. Sagar PM, Gauperaa T, Sue-Ling H, McMahon MJ, Johnston D. An audit of the treatment of cancer of the oesophagus. Gut 1994;35:941–945.

    Article  PubMed  CAS  Google Scholar 

  7. Sariego J, Mosher S, Byrd M, Matsumoto T, Kerstein M. Prediction of outcome in "resectable" esophageal carcinoma. J Surg Oncol 1993;54:223–225.

    Article  PubMed  CAS  Google Scholar 

  8. Sondenaa K, Skaane P, Nygaard K, Skjennald A. Value of computed tomography in preoperative evaluation of resectability and staging in oesophageal carcinoma. Eur J Surg 1992; 158:537–540.

    PubMed  CAS  Google Scholar 

  9. Clements DM, Bowrey DJ, Havard TJ. The role of staging investigations for oesophago-gastric carcinoma. Eur J Surg Oncol 2004;30:309–312.

    Article  PubMed  CAS  Google Scholar 

  10. Wakelin SJ, Deans C, Crofts TJ, Allan PL, Plevris JN. Paterson-Brown SA comparison of computerised tomography, laparoscopic ultrasound and endoscopic ultrasound in the preoperative staging of oesophago-gastric carcinoma. Eur J Radiol 2002;41:161–167.

    Article  PubMed  Google Scholar 

  11. Eloubeidi MA, Wallace MB, Reed CE, et al. The utility of EUS and EUS-guided fine needle aspiration in detecting celiac lymph node metastasis in patients with esophageal cancer: A single-center experience. Gastrointest Endosc 2001; 54:714–719.

    Article  PubMed  CAS  Google Scholar 

  12. Kelly S, Harris KM, Berry E, et al. A systematic review of the staging performance of endoscopic ultrasound in gastrooesophageal carcinoma. Gut 2001;49:534–539.

    Article  PubMed  CAS  Google Scholar 

  13. Parmar KS, Zwischenberger JB, Reeves AL, Waxman I. Clinical impact of endoscopic ultrasound-guided fine needle aspiration of celiac axis lymph nodes (M1a disease) in esophageal cancer. Ann Thorac Surg 2002;73:916–920.

    Article  PubMed  Google Scholar 

  14. Flamen P, Lerut A, Van Cutsem E, et al. Utility of positron emission tomography for the staging of patients with potentially operable esophageal carcinoma. J Clin Oncol 2000; 18:3202–3210.

    PubMed  CAS  Google Scholar 

  15. Kole AC, Plukker JT, Nieweg OE, Vaalburg W. Positron emission tomography for staging of oesophageal and gastroesophageal malignancy. Br J Cancer 1998;78:521–527.

    PubMed  CAS  Google Scholar 

  16. Lightdale CJ. Esophageal cancer. Am J Gastroenterol 1999; 94:20–29.

    Article  PubMed  CAS  Google Scholar 

  17. Sobin LH, Wittekind C. TNM Classification of Malignant Tumours. 6th ed. New York: John Wiley & Sons, 2003.

    Google Scholar 

  18. Eloubeidi MA, Wallace MB, Hoffman BJ, et al. Predictors of survival for esophageal cancer patients with and without celiac axis lymphadenopathy: Impact of staging endosonography. Ann Thorac Surg 2001;72:212–219.

    Article  PubMed  CAS  Google Scholar 

  19. Hiele M, de Leyn P, Schurmans P, et al. Relation between endoscopic ultrasound findings and outcome of patients with tumors of the esophagus or esophagogastric junction. Gastrointest Endosc 1997;45:381–386.

    Article  PubMed  CAS  Google Scholar 

  20. Clark GW, Peters JH, Ireland AP, et al. Nodal metastasis and sites of recurrence after en bloc esophagectomy for adenocarcinoma. Ann Thorac Surg 1994;58:646–653.

    Article  PubMed  CAS  Google Scholar 

  21. Van Westreenen HL, Pultrum BB, Plukker JT. Outcome in patients with stage IV esophageal cancer detected during explorative surgery. Eur J Surg Oncol 2004;30:182–183(abstr).

    Google Scholar 

  22. Surgical resection with or without preoperative chemotherapy in oesophageal cancer: A randomised controlled trial. Lancet 2002;359:1727-1733.

  23. Kelsen DP, Ginsberg R, Pajak TF, et al. Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med 1998;339:1979–1984.

    Article  PubMed  CAS  Google Scholar 

  24. Kumbasar B. Carcinoma of esophagus: Radiologic diagnosis and staging. Eur J Radiol 2002;42:170–180.

    Article  PubMed  Google Scholar 

  25. Lightdale CJ. Positron emission tomography: Another useful test for staging esophageal cancer. J Clin Oncol 2000;18:3199–3201.

    PubMed  CAS  Google Scholar 

  26. Romagnuolo J, Scott J, Hawes RH, et al. Helical CT versus EUS with fine needle aspiration for celiac nodal assessment in patients with esophageal cancer. Gastrointest Endosc 2002;55:648–654.

    Article  PubMed  Google Scholar 

  27. Thompson WM, Halvorsen RA Jr. Staging esophageal carcinoma II: CT and MRI. Semin Oncol 1994;21:447–452.

    PubMed  CAS  Google Scholar 

  28. Rice TW. Clinical staging of esophageal carcinoma. CT, EUS, and PET. Chest Surg Clin North Am 2000;10:471–485.

    CAS  Google Scholar 

  29. Salminen JT, Farkkila MA, Ramo OJ, et al. Endoscopic ultrasonography in the preoperative staging of adenocarcinoma of the distal oesophagus and oesophagogastric junction. Scand J Gastroenterol 1999;34:1178–1182.

    Article  PubMed  CAS  Google Scholar 

  30. Flanagan FL, Dehdashti F, Siegel BA, et al. Staging of esophageal cancer with 18F-.uorodeoxyglucose positron emission tomography. AJR Am J Roentgenol 1997;168:417–424.

    PubMed  CAS  Google Scholar 

  31. Van Westreenen HL, Heeren PA, Jager PL, van Dullemen HM, Groen H, Plukker JT. Pitfalls of positive findings in staging esophageal cancer with F-18-.uorodeoxyglucose positron emission tomography. Ann Surg Oncol 2003;10:1100–1105.

    Article  PubMed  Google Scholar 

  32. Harewood GC, Wiersema MJ. A cost analysis of endoscopic ultrasound in the evaluation of esophageal cancer. Am J Gastroenterol 2002;97:452–458.

    Article  PubMed  Google Scholar 

  33. Wallace MB, Nietert PJ, Earle C, et al. An analysis of multiple staging management strategies for carcinoma of the esophagus: Computed tomography, endoscopic ultrasound, positron emission tomography, and thoracoscopy/laparoscopy. Ann Thorac Surg 2002;74:1026–1032.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Oncology, University Hospital Groningen, P.O. Box 30001, 9700, RB Groningen, the Netherlands

    Henderik L. van Westreenen M.D., Pierre A. M. Heeren M.D. & John Th. M. Plukker M.D., Ph.D.

  2. Department of Surgical Gastroenterology, University Hospital Groningen, Groningen, the Netherlands

    Hendrik M. van Dullemen M.D., Ph.D.

  3. Department of Surgical Radiology, University Hospital Groningen, Groningen, the Netherlands

    Eric J. van der Jagt M.D., Ph.D.

  4. Department of Surgical Oncology and Nuclear Medicine/PET Center, University Hospital Groningen, Groningen, the Netherlands

    Pieter L. Jager M.D., Ph.D.

  5. Department of Surgical Oncology and Office for Medical Technology Assessment, University Hospital Groningen, Groningen, the Netherlands

    Henk Groen M.D., Ph.D.

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  1. Henderik L. van Westreenen M.D.
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  2. Pierre A. M. Heeren M.D.
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  3. Hendrik M. van Dullemen M.D., Ph.D.
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  4. Eric J. van der Jagt M.D., Ph.D.
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  5. Pieter L. Jager M.D., Ph.D.
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  7. John Th. M. Plukker M.D., Ph.D.
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Correspondence to Henderik L. van Westreenen M.D..

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van Westreenen, H.L., Heeren, P.A.M., van Dullemen, H.M. et al. Positron emission tomography with F-18-fluorodeoxyglucose in a combined staging strategy of esophageal cancer prevents unnecessary surgical explorations. J Gastrointest Surg 9, 54–61 (2005). https://doi.org/10.1016/j.gassur.2004.09.055

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