Skip to main content

Advertisement

SpringerLink
Log in

Prognostic significance of endoscopic ultrasound-defined pleural, pericardial or peritoneal fluid in oesophageal cancer

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Endoscopic ultrasound (EUS) is known to detect smaller effusion volumes than computerised tomography (CT), yet the outcomes for patients diagnosed with oesophageal carcinoma and EUS-defined pleural, pericardial or ascitic fluid effusions (EDFE) are unknown. The aim of this study was to determine the outcome of multidisciplinary stage directed treatment for such patients.

Methods

Forty-nine (9.2%) out of a consecutive 527 patients diagnosed with oesophageal cancer from a single regional upper gastrointestinal (GI) cancer network were found to have evidence of EDFE undetected by CT. Thirty-nine (79.6%) patients had pleural effusions, eight (16.3%) pericardial effusions, and two (4.1%) ascites.

Results

Twelve (24.4%) underwent surgery, 3 (6.1%) received neoadjuvant chemotherapy without subsequent surgery, 12 (24.5%) received definitive chemoradiotherapy (dCRT), and 22 (44.9%) received palliative treatment. Survival in patients with EDFE was significantly shorter (median and 2-year survival 15.6 months and 24%, respectively) when compared with patients without EDFE (26.7 months and 40%, respectively, p = 0.001), and was unrelated to EDFE type (p = 0.192). Two-year survival after oesophagectomy with or without neoadjuvant therapy was 45% in patients with EDFE compared with 42% in patients without EDFE (p = 0.668).

Conclusions

EDFE was an important adverse prognostic indicator, but patients deemed to have operable tumours should still be treated with radical intent.

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

Similar content being viewed by others

References

  1. Kelly S, Harris KM, Berry E, Hutton J, Roderick P, Cullingworth J, Gathercole L, Smith MA (2001) A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma. Gut 49:534–539

    Article  CAS  PubMed  Google Scholar 

  2. Caputo FM, Buquicchio GL (2005) Esophageal cancer staging: the role of radiology. Rays 30:309–314

    PubMed  Google Scholar 

  3. Chang KJ, Albers CG, Nguyen P (1995) Endoscopic ultrasound-guided fine needle aspiration of pleural and ascitic fluid. Am J Gastroenterol 90:148–150

    CAS  PubMed  Google Scholar 

  4. DeWitt J, LeBlanc J, McHenry L, McGreevy K, Sherman S (2007) Endoscopic ultrasound-guided fine-needle aspiration of ascites. Clin Gastroenterol Hepatol 5:609–615

    Article  PubMed  Google Scholar 

  5. 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 

  6. Sultan J, Robinson S, Hayes N, Griffin SM, Richardson DL, Preston SR (2008) Endoscopic ultrasonography-detected low-volume ascites as a predictor of inoperability for oesophagogastric cancer. Br J Surg 95:1127–1130

    Article  CAS  PubMed  Google Scholar 

  7. Renshaw AA, Nappi D, Sugarbaker DJ, Swanson S (1997) Effusion cytology of esophageal carcinoma. Cancer 81:365–372

    Article  CAS  PubMed  Google Scholar 

  8. Sobin LH, Wittekind CH (1997) UICC TNM classification of malignant tumours. Wiley, New York

    Google Scholar 

  9. Bowrey DJ, Clark GW, Roberts SA, Maughan TS, Hawthorne AB, Williams GT, Carey PD (1999) Endosonographic staging of 100 consecutive patients with esophageal carcinoma: introduction of the 8-mm esophagoprobe. Dis Esophagus 12:258–263

    Article  CAS  PubMed  Google Scholar 

  10. Stephens MR, Lewis WG, Brewster AE, Lord I, Blackshaw GR, Hodzovic I, Thomas GV, Roberts SA, Crosby TD, Gent C, Allison MC, Shute K (2006) Multidisciplinary team management is associated with improved outcomes after surgery for esophageal cancer. Dis Esophagus 19:164–171

    Article  CAS  PubMed  Google Scholar 

  11. Lewis I (1964) The surgical treatment of carcinoma of the oesophagus, with special reference to a new operation for growths of the middle third. Br J Surg 51:53–68

    Article  Google Scholar 

  12. Orringer MB (1984) Transhiatal esophagectomy without thoracotomy for carcinoma of the thoracic esophagus. Ann Surg 200:282–288

    Article  CAS  PubMed  Google Scholar 

  13. Crosby TD, Brewster AE, Borley A, Perschky L, Kehagioglou P, Court J, Maughan TS (2004) Definitive chemoradiation in patients with inoperable oesophageal carcinoma. Br J Cancer 90:70–75

    Article  CAS  PubMed  Google Scholar 

  14. Morgan MA, Lewis WG, Casbard A, Roberts SA, Adams R, Clark GW, Havard TJ, Crosby TD (2008) Stage for stage comparison of definitive chemoradiation, surgery alone and neoadjuvant chemotherapy for oesophageal carcinoma. Br J Surg (in press)

  15. Kaplan EL, Meier P (1958) Non-parametric estimation from incomplete observations. J Am Stat Assoc 58:457–481

    Article  Google Scholar 

  16. Landis JR, Kock GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  17. Cox DR (1972) Regression models and life tables. J R Stat Soc B:187–200

    Google Scholar 

  18. Barry JD, Edwards P, Lewis WG, Dhariwal D, Thomas GV (2002) Special interest radiology improves the perceived preoperative stage of gastric cancer. Clin Radiol 57:984–988

    Article  CAS  PubMed  Google Scholar 

  19. Morgan MA, Lewis WG, Crosby TD, Escofet X, Roberts SA, Brewster AE, Harvard TJ, Clark GW (2007) Prospective cohort comparison of neoadjuvant chemoradiotherapy versus chemotherapy in patients with oesophageal cancer. Br J Surg 94:1509–1514

    Article  CAS  PubMed  Google Scholar 

  20. Morgan MA, Lewis WG, Hopper AN, Escofet X, Havard TJ, Brewster AE, Crosby TD, Roberts SA, Clark GW (2007) Prospective comparison of transthoracic versus transhiatal esophagectomy following neoadjuvant therapy for esophageal cancer. Dis Esophagus 20:225–231

    Article  CAS  PubMed  Google Scholar 

  21. Weaver SR, Blackshaw GR, Lewis WG, Edwards P, Roberts SA, Thomas GV, Allison MC (2004) Comparison of special interest computed tomography, endosonography and histopathological stage of oesophageal cancer. Clin Radiol 59:499–504

    Article  CAS  PubMed  Google Scholar 

  22. Gheorghe C, Stanescu C, Gheorghe L, Bancila I, Herlea V, Becheanu G, Voinea D, Iacob R, Lupescu I, Anghel R, Croitoru A, Popescu I (2006) Preoperative noninvasive EUS evaluation in patients with esophageal cancer considered for esophagectomy. J Gastrointestin Liver Dis 15:137–141

    PubMed  Google Scholar 

  23. Moorjani N, Junemann-Ramirez M, Judd O, Fox B, Rahamim JS (2007) Endoscopic ultrasound in oesophageal carcinoma: comparison with multislice computed tomography and importance in the clinical decision making process. Minerva Chir 62:217–223

    CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  25. Zuccaro G Jr, Rice TW, Vargo JJ, Goldblum JR, Rybicki LA, Dumot JA, Adelstein DJ, Trolli PA, Blackstone EH (2005) Endoscopic ultrasound errors in esophageal cancer. Am J Gastroenterol 100:601–606

    PubMed  Google Scholar 

  26. Al-Sarira AA, David G, Willmott S, Slavin JP, Deakin M, Corless DJ (2007) Oesophagectomy practice and outcomes in England. Br J Surg 94:585–591

    Article  CAS  PubMed  Google Scholar 

  27. Medical Research Council Oesophageal Cancer Working Group (2002) Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet 359:1727–1733

    Article  Google Scholar 

  28. Dexter SP, Sue-Ling H, McMahon MJ, Quirke P, Mapstone N, Martin IG (2001) Circumferential resection margin involvement: an independent predictor of survival following surgery for oesophageal cancer. Gut 48:667–670

    Article  CAS  PubMed  Google Scholar 

  29. Khan OA, Fitzgerald JJ, Soomro I, Beggs FD, Morgan WE, Duffy JP (2003) Prognostic significance of circumferential resection margin involvement following oesophagectomy for cancer. Br J Cancer 88:1549–1552

    Article  CAS  PubMed  Google Scholar 

  30. Khan OA, Alexiou C, Soomro I, Duffy JP, Morgan WE, Beggs FD (2004) Pathological determinants of survival in node-negative oesophageal cancer. Br J Surg 91:1586–1591

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. South East Wales Cancer Network, University Hospital of Wales, Cardiff, UK

    Christopher P. Twine, Jonathan D. Barry, Guy R. J. Blackshaw, Tom D. Crosby, S. Ashley Roberts & Wyn G. Lewis

  2. Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK

    Christopher P. Twine, Jonathan D. Barry, Guy R. J. Blackshaw & Wyn G. Lewis

  3. Department of Oncology, Velindre Hospital, Cardiff, UK

    Tom D. Crosby

  4. Department of Radiology, University Hospital of Wales, Cardiff, UK

    S. Ashley Roberts

Authors
  1. Christopher P. Twine
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jonathan D. Barry
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guy R. J. Blackshaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tom D. Crosby
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Ashley Roberts
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wyn G. Lewis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wyn G. Lewis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Twine, C.P., Barry, J.D., Blackshaw, G.R.J. et al. Prognostic significance of endoscopic ultrasound-defined pleural, pericardial or peritoneal fluid in oesophageal cancer. Surg Endosc 23, 2229–2236 (2009). https://doi.org/10.1007/s00464-008-0286-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-008-0286-1

Keywords

Search

Navigation