Abstract
Background
Conventional preoperative staging for esophageal carcinoma could be inaccurate. Laparoscopy has been applied for the staging of various upper gastrointestinal malignancies. It can identify peritoneal and liver deposits not shown by imaging, and could reduce the number of nontherapeutic laparotomies. This study aimed to evaluate the efficacy of laparoscopic staging for the management of squamous cell carcinoma involving the mid and distal esophagus.
Methods
A retrospective review was performed for all patients with esophageal cancer evaluated for surgical resection from January 1998 to January 2004. Laparoscopy was performed for all the patients with mid and distal esophageal cancer immediately before open gastric mobilization. The efficacy of laparoscopy for the management of squamous cell carcinoma of the esophagus was evaluated.
Results
Among the 63 patients with potentially resectable disease shown on conventional imaging, 54 (84%) underwent esophagectomy with curative intent after laparoscopic staging. Seven patients (11%) underwent laparoscopy alone because of abdominal metastases (n = 5) or other medical conditions (n = 2) that precluded esophagectomy. Two patients (3%) had exploratory right thoracotomy without esophagectomy despite normal laparoscopic findings. The sensitivity and specificity of laparoscopic staging were 100% in this series of patients (100% sensitivity and specificity means no false-positives or -negatives).
Conclusion
Laparoscopic staging is valuable for the management of patients with mid and distal squamous cell carcinoma of the esophagus. Patients with metastatic disease and those with prohibitive surgical risk can thus avoid unnecessary laparotomy and be offered other treatment methods.
Similar content being viewed by others
References
Akiyama H, Tsurumaru M, Udagawa H, Kajiyama Y (1994) Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg 220: 364–372
Flamen P, Lerut A, Van Cutsem E, De Wever W, Peeters M, Stroobants S, Dupont P, Bormans G, Hiele M, De Leyn P, Van Raemdonck D, Coosemans W, Ectors N, Haustermans K, Mortelmans L (2000) Utility of positron emission tomography for the staging of patients with potentially operable esophageal carcinoma. J Clin Oncol 18: 3202–3210
Heath EI, Kaufman HS, Talamini MA, Wu TT, Wheeler J, Heitmiller RF, Kleinberg L, Yang SC, Olukayode K, Forastiere AA (2001) The role of laparoscopy in preoperative staging of esophageal cancer. Surg Endosc 15: 528–529
Hospital Authority Statistical Report 2001–2002 (2003) Statistic and Research Unit, Professional & Medical Development Division, Hospital Authority, Hong Kong Special Administrative Region 33,57,60
John TG, Garden OJ (1994) Laparoscopic ultrasonography: extending the scope of diagnostic laparoscopy. Br J Surg 81: 5–6
John TG, Greig JD, Carter DC, Garden OJ (1995) Carcinoma of the pancreatic head and periampullary region: tumor staging with laparoscopy and laparoscopic ultrasonography. Ann Surg 221: 156–164
John TG, Greig JD, Crosbie JL, Miles WF, Garden OJ (1994) Superior staging of liver tumors with laparoscopy and laparoscopic ultrasound. Ann Surg 220: 711–719
Kim K, Park SJ, Kim B-T, Lee KS, Shim YM (2001) Evaluation of lymph node metastasis in squamous cell carcinoma of the esophagus with positron emission tomography. Ann Thorac Surg 71: 290–294
Krasna MJ, Flowers JL, Attar S, McLaughlin J (1996) Combined thoracoscopic/laparoscopic staging of esophageal cancer. J Thorac Cardiovasc Surg 111: 800–807
Krasna MJ, Jiao X, Mao YS, Sonett J, Gamliel Z, Kwong K, Burrows W, Flowers JL, Greenwald B, White C (2002) Thoracoscopy/laparoscopy in the staging of esophageal cancer: Maryland experience. Surg Laparosc Endosc Percutan Tech 12: 213–218
Law SY, Wong J (2002) Changing disease burden and management issues for esophageal cancer in the Asia–Pacific region. J Gastroenterol Hepatol 17: 374–381
Lightdale CJ (1994) Staging of esophageal cancer: I. Endoscopic ultrasonography. Semin Oncol 21: 438–446
Luketich JD, Friedman DM, Weigel TL, Meehan MA, Keenan RJ, Townsend DW, Meltzer CC (1999) Evaluation of distant metastases in esophageal cancer: 100 consecutive positron emission tomography scans. Ann Thorac Surg 68: 1133–1137
Luketich JD, Meehan M, Nguyen NT, Christie N, Weigel T, Yousem S, Keenan RJ, Schauer PR (2000) Minimally invasive surgical staging for esophageal cancer. Surg Endosc 14: 700–702
Luketich JD, Schauer P, Landreneau R, Nguyen N, Urso K, Ferson P, Keenan R, Kim R (1997) Minimally invasive surgical staging is superior to endoscopic ultrasound in detecting lymph node metastases in esophageal cancer. J Thorac Cardiovasc Surg 114: 817–823
Molly RG, McCourtney JS, Anderson JR (1995) Laparoscopy in the management of patients with cancer of the gastric cardia and oesophagus. Br J Surg 82: 352–354
Nguyen NT, Roberts PF, Follette DM, Lau D, Lee J, Urayama S, Wolfe BM, Goodnight JE (2001) Evaluation of minimally invasive surgical staging for esophageal cancer. Am J Surg 182: 702–706
Orringer MB, Marshall B, Iannettoni MD (1999) Transhiatal esophagectomy: clinical experience and refinements. Ann Surg 230: 392–400
Reed CE, Mishra G, Sahai AV, Hoffman BJ, Hawes RH (1999) Esophageal cancer staging: improved accuracy by endoscopic ultrasound of coeliac lymph nodes. Ann Thorac Surg 67: 319–322
Rigo P, Paulus P, Kaschten BJ, Hustinx R, Bury T, Jerusalem G, Benoit T, Foidart-Willems J (1996) Oncological applications of positron emission tomography with fluorine-18 fluorodeoxyglucose. Eur J Nucl Med 23: 1641–1674
Romijn MG, van Overhagen H, Bilgen EJ Spillenaar, Ijzermans JNM, Tilanus HW, Lameris JS (1998) Laparoscopy and laparoscopic ultrasonography in staging of oesophageal and cardial carcinoma. Br J Surg 85: 1010–1012
Thompson WM, Halvorsen RA Jr (1994) Staging esophageal carcinoma: II. CT and MRI. Semin Oncol 21: 447–452
Velasco JM, Rossi H, Hieken TJ, Fernandez M (2000) Laparsocopic ultrasound enhances diagnostic laparoscopy in the staging of intraabdominal neoplasms. Am Surg 66: 407–411
Wallace MB, Hawes RH, Sahai AV, Van Velse A, Hoffman BJ (2000) Dilatation of malignant esophageal stenosis to allow EUS guided fine-needle aspiration: safety and effect on patient management. Gastrointest Endosc 51: 309–313
Weber WA, Avril N, Schwaiger M (1999) Relevance of positron emission tomography (PET) in oncology. Strahlenther Onkol 175: 356–373
Whooley BP, Law S, Murthy SC, Alexandrou A, Wong J (2001) Analysis of reduced death and complication rates after esophageal resection. Ann Surg 233: 338–344
Williams DB, Hoffman BJ (1999) Complications of interventional endoscopic ultrasonography. In: Bhutani M (ed) Interventional endoscopic ultrasonography. Vol 1. Harwood Academic Publishers, Amsteldijk, the Netherlands pp 151–158
Zhang DW, Cheng GY, Huang GJ, Zhang RG, Liu XY, Mao YS, Wang YG, Chen SJ, Zhang LZ, Wang LJ (1994) Operable squamous esophageal cancer: current results from the east. World J Surg 18: 347–354
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yau, K.K., Siu, W.T., Cheung, H.Y.S. et al. Immediate preoperative laparoscopic staging for squamous cell carcinoma of the esophagus. Surg Endosc 20, 307–310 (2006). https://doi.org/10.1007/s00464-005-0336-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-005-0336-x