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Preoperative Assessment of Tumor Location and Station-Specific Lymph Node Status in Patients with Adenocarcinoma of the Gastroesophageal Junction

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Abstract

Background

In esophageal cancer patients preoperative staging will determine the type of surgical procedure and use of neoadjuvant therapy. Tumor location and lymph node status play a pivotal role in this tailored strategy. The aim of the present study was to prospectively evaluate the accuracy of preoperative assessment of tumor location according to the Siewert classification and lymph node status per station with endoscopy/endoscopic ultrasound (EUS) and computed tomography (CT).

Methods

In 50 esophagectomy patients with adenocarcinoma of the gastroesophageal junction (GEJ), tumor location according to Siewert and N-stage per nodal station as determined preoperatively by endoscopy/EUS and CT were compared with the histopathologic findings in the resection specimen.

Results

Overall accuracy in predicting tumor location according to the Siewert classification was 70 % for endoscopy/EUS and 72 % for CT. Preoperative data could not be compared with the pathologic assessment in 11 patients (22 %), as large tumors obscured the landmark of the gastric folds. The overall accuracy for predicting the N-stage in 250 lymph node stations was 66 % for EUS and 68 % for CT. The accuracy was good for those stations located high in the thorax, but poor for celiac trunk nodes.

Conclusions

Given the frequent discrepancy between the endoscopic and pathologic location of the GEJ and the common problem of advanced tumors obscuring the landmarks used in the assessment of the Siewert classification, its usefulness is limited. The overall accuracy for EUS and CT in predicting the N-stage per station was moderate.

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References

  1. Hulscher JB, Van Lanschot JJ (2005) Individualised surgical treatment of patients with an adenocarcinoma of the distal oesophagus or gastro-oesophageal junction. Dig Surg 22:130–134

    Article  PubMed  CAS  Google Scholar 

  2. Stein HJ, Brucher BL, Sendler A et al (2001) Esophageal cancer: patient evaluation and pre-treatment staging. Surg Oncol 10:103–111

    Article  PubMed  CAS  Google Scholar 

  3. Von Rahden BH, Stein HJ, Siewert JR (2006) Surgical management of esophagogastric junction tumors. World J Gastroenterol 12:6608–6613

    Google Scholar 

  4. Siewert JR, Stein HJ (1998) Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg 85:1457–1459

    Article  PubMed  CAS  Google Scholar 

  5. Sobin L (2002) TNM Classification of Malignant Tumors. Wiley, New York

    Google Scholar 

  6. Bergman JJ (2006) The endoscopic diagnosis and staging of oesophageal adenocarcinoma. Best Pract Res Clin Gastroenterol 20:843–866

    Article  PubMed  Google Scholar 

  7. Bergman JJ, Fockens P (1999) Endoscopic ultrasonography in patients with gastro-esophageal cancer. Eur J Ultrasound 10:127–138

    Article  PubMed  CAS  Google Scholar 

  8. DeMeester SR (2006) Adenocarcinoma of the esophagus and cardia: a review of the disease and its treatment. Ann Surg Oncol 13:12–30

    Article  PubMed  Google Scholar 

  9. Van Vliet EP, Heijenbrok-Kal MH, Hunink MG et al (2008) Staging investigations for oesophageal cancer: a meta-analysis. Br J Cancer 98:547–557

    Article  PubMed  Google Scholar 

  10. Rosch T (1995) Endosonographic staging of esophageal cancer: a review of literature results. Gastrointest Endosc Clin N Am 5:537–547

    PubMed  CAS  Google Scholar 

  11. Van Dam J (1997) Endosonographic evaluation of the patient with esophageal cancer. Chest 112:184S–190S

    Article  PubMed  Google Scholar 

  12. Caletti G, Bocus P, Fusaroli P et al (1998) Cancer of the esophagus—endoscopic ultrasound: selection for cure. Can J Gastroenterol 12:341–346

    PubMed  CAS  Google Scholar 

  13. Kutup A, Link BC, Schurr PG et al (2007) Quality control of endoscopic ultrasound in preoperative staging of esophageal cancer. Endoscopy 39:715–719

    Article  PubMed  CAS  Google Scholar 

  14. Heeren PA, Van Westreenen HL, Geersing GJ et al (2004) Influence of tumor characteristics on the accuracy of endoscopic ultrasonography in staging cancer of the esophagus and esophagogastric junction. Endoscopy 36:966–971

    Article  PubMed  CAS  Google Scholar 

  15. Zhang X, Watson DI, Lally C et al (2005) Endoscopic ultrasound for preoperative staging of esophageal carcinoma. Surg Endosc 19:1618–1621

    Article  PubMed  CAS  Google Scholar 

  16. Vazquez-Sequeiros E, Wiersema MJ, Clain JE et al (2003) Impact of lymph node staging on therapy of esophageal carcinoma. Gastroenterology 125:1626–1635

    Article  PubMed  Google Scholar 

  17. Peters CJ, Hardwick RH, Vowler SL et al (2009) Generation and validation of a revised classification for oesophageal and junctional adenocarcinoma. Br J Surg 96:724–733

    Article  PubMed  CAS  Google Scholar 

  18. Cunningham D, Allum WH, Stenning SP et al (2006) Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 355:11–20

    Article  PubMed  CAS  Google Scholar 

  19. Van Hagen P, Hulshof MC, Van Lanschot JJ et al (2012) Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366:2074–2084

    Article  PubMed  Google Scholar 

  20. Boonstra JJ, Koppert LB, Wijnhoven BP et al (2009) Chemotherapy followed by surgery in patients with carcinoma of the distal esophagus and celiac lymph node involvement. J Surg Oncol 100:407–413

    Article  PubMed  CAS  Google Scholar 

  21. Hulscher JB, Van Sandick JW, de Boer AG et al (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347:1662–1669

    Article  PubMed  Google Scholar 

  22. Omloo JM, Lagarde SM, Hulscher JB et al (2007) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg 246:992–1000; discussion 1000–1001

    Article  PubMed  Google Scholar 

  23. Umeoka S, Koyama T, Togashi K et al (2006) Esophageal cancer: evaluation with triple-phase dynamic CT—initial experience. Radiology 239:777–783

    Article  PubMed  Google Scholar 

  24. Ba-Ssalamah A, Zacherl J, Noebauer-Huhmann IM et al (2009) Dedicated multi-detector CT of the esophagus: spectrum of diseases. Abdom Imaging 34:3–18

    Article  PubMed  Google Scholar 

  25. Feith M, Stein HJ, Siewert JR (2003) Pattern of lymphatic spread of Barrett’s cancer. World J Surg 27:1052–1057. doi:10.1007/s00268-003-7060-2

    Article  PubMed  Google Scholar 

  26. Cense HA, Van Eijck CH, Tilanus HW (2006) New insights in the lymphatic spread of oesophageal cancer and its implications for the extent of surgical resection. Best Pract Res Clin Gastroenterol 20:893–906

    Article  PubMed  CAS  Google Scholar 

  27. Van de Ven C, De Leyn P, Coosemans W et al (1999) Three-field lymphadenectomy and pattern of lymph node spread in T3 adenocarcinoma of the distal esophagus and the gastro-esophageal junction. Eur J Cardiothorac Surg 15:769–773

    Article  PubMed  Google Scholar 

  28. Bhutani MS, Hawes RH, Hoffman BJ (1997) A comparison of the accuracy of echo features during endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration for diagnosis of malignant lymph node invasion. Gastrointest Endosc 45:474–479

    Article  PubMed  CAS  Google Scholar 

  29. Catalano MF, Sivak MV Jr, Rice T et al (1994) Endosonographic features predictive of lymph node metastasis. Gastrointest Endosc 40:442–446

    Article  PubMed  CAS  Google Scholar 

  30. Pedrazzani C, Bernini M, Giacopuzzi S et al (2005) Evaluation of Siewert classification in gastro-esophageal junction adenocarcinoma: what is the role of endoscopic ultrasonography? J Surg Oncol 91:226–231

    Article  PubMed  Google Scholar 

  31. Leers JM, DeMeester SR, Chan N et al (2009) Clinical characteristics, biologic behavior, and survival after esophagectomy are similar for adenocarcinoma of the gastroesophageal junction and the distal esophagus. J Thorac Cardiovasc Surg 138:594–602; discussion 601–602

    Article  PubMed  Google Scholar 

  32. Chandrasoma P (2005) Controversies of the cardiac mucosa and Barrett’s oesophagus. Histopathology 46:361–373

    Article  PubMed  CAS  Google Scholar 

  33. Chandrasoma P, Makarewicz K, Wickramasinghe K et al (2006) A proposal for a new validated histological definition of the gastroesophageal junction. Hum Pathol 37:40–47

    Article  PubMed  Google Scholar 

  34. Ringhofer C, Lenglinger J, Eisler M et al (2007) Videoendoscopy and histopathology of the esophagogastric junction in patients with gastroesophageal reflux disease. Wien Klin Wochenschr 119:283–290

    Article  PubMed  Google Scholar 

  35. Catalano MF, Van Dam J, Sivak MV et al (1995) Malignant esophageal strictures: staging accuracy of endoscopic ultrasonography. Gastrointest Endosc 41:535–539

    Article  PubMed  CAS  Google Scholar 

  36. Abdalla EK, Pisters PW (2004) Staging and preoperative evaluation of upper gastrointestinal malignancies. Semin Oncol 31:513–529

    Article  PubMed  Google Scholar 

  37. Eloubeidi MA, Wallace MB, Reed CE et al (2001) 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 54:714–719

    Article  PubMed  CAS  Google Scholar 

  38. Puli SR, Reddy JB, Bechtold ML et al (2008) Accuracy of endoscopic ultrasound in the diagnosis of distal and celiac axis lymph node metastasis in esophageal cancer: a meta-analysis and systematic review. Dig Dis Sci 53:2405–2414

    Article  PubMed  Google Scholar 

  39. Mortensen MB, Edwin B, Hunerbein M et al (2007) Impact of endoscopic ultrasonography (EUS) on surgical decision-making in upper gastrointestinal tract cancer: an international multicenter study. Surg Endosc 21:431–438

    Article  PubMed  CAS  Google Scholar 

  40. Subasinghe D, Samarasekera DN (2009) A study comparing endoscopic ultrasound (EUS) and computed tomography (CT) in staging oesophageal cancer and their role in clinical decision making. J Gastrointest Cancer 41:38–42

    Article  Google Scholar 

  41. Vilmann P (1996) Endoscopic ultrasonography-guided fine-needle aspiration biopsy of lymph nodes. Gastrointest Endosc 43:S24–S29

    Article  PubMed  CAS  Google Scholar 

  42. Marsman WA, Brink MA, Bergman JJ et al (2006) Potential impact of EUS-FNA staging of proximal lymph nodes in patients with distal esophageal carcinoma. Endoscopy 38:825–829

    Article  PubMed  CAS  Google Scholar 

  43. Plukker JT, Van Westreenen HL (2006) Staging in oesophageal cancer. Best Pract Res Clin Gastroenterol 20:877–891

    Article  PubMed  Google Scholar 

  44. Harisinghani MG, Barentsz J, Hahn PF et al (2003) Noninvasive detection of clinically occult lymph-node metastases in prostate cancer. N Engl J Med 348:2491–2499

    Article  PubMed  Google Scholar 

  45. Koh DM, Brown G, Temple L et al (2004) Rectal cancer: mesorectal lymph nodes at MR imaging with USPIO versus histopathologic findings—initial observations. Radiology 231:91–99

    Article  PubMed  Google Scholar 

  46. Nishimura H, Tanigawa N, Hiramatsu M et al (2006) Preoperative esophageal cancer staging: magnetic resonance imaging of lymph node with ferumoxtran-10, an ultrasmall superparamagnetic iron oxide. J Am Coll Surg 202:604–611

    Article  PubMed  Google Scholar 

  47. Fein M, Fuchs KH, Ritter MP et al (1998) Application of the new classification for cancer of the cardia. Surgery 124:707–713; discussion 713–704

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands

    Brechtje A. Grotenhuis, Bas P. L. Wijnhoven, Hugo W. Tilanus & J. Jan B. van Lanschot

  2. Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands

    Jan Werner Poley, Manon C. W. Spaander & Marco J. Bruno

  3. Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands

    John J. Hermans

  4. Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands

    Katharina Biermann

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  1. Brechtje A. Grotenhuis
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  2. Bas P. L. Wijnhoven
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  9. J. Jan B. van Lanschot
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Correspondence to Brechtje A. Grotenhuis.

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Grotenhuis, B.A., Wijnhoven, B.P.L., Poley, J.W. et al. Preoperative Assessment of Tumor Location and Station-Specific Lymph Node Status in Patients with Adenocarcinoma of the Gastroesophageal Junction. World J Surg 37, 147–155 (2013). https://doi.org/10.1007/s00268-012-1804-9

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