May 1994

Selection of Patients for Curative or Palliative Resection of Esophageal Cancer Based on Preoperative Endoscopic Ultrasonography

Author Affiliations

From the Departments of Surgery (Drs Peters, Hoeft, Heimbucher, R. Bremner, DeMeester, C. Bremner, and Clark), Pathology (Dr Kiyabu), and Radiology (Dr Parisky), the University of Southern California School of Medicine, Los Angeles.

Arch Surg. 1994;129(5):534-539. doi:10.1001/archsurg.1994.01420290080012

Objective:  To assess the accuracy of pretreatment staging and the potential of using endosonographic findings to select patients for curative or palliative resection by comparing the preoperative endosonographic and computed tomographic (CT) findings with the histology of the surgical specimen.

Methods:  Forty-two patients referred to our clinic with esophageal carcinoma underwent preoperative upper endoscopy with biopsy, endosonography, thoracic CT, and abdominal CT. Based on endoscopic ultrasonographic findings, patients with early-stage disease underwent enbloc esophagogastrectomy, whereas those with advanced disease had a palliative transhiatal esophagectomy. Exceptions included patients with poor physiologic reserve who were treated by the transhiatal route.

Results:  In eight patients, we were unable to pass the ultrasonographic endoscope. Seven of these eight had transmural tumors with nodal involvement on histologic study. Tumor length, based on endosonographic measurements, was correctly predicted in 34 patients (85%). Extent of wall penetration was accurately predicted in 26 (76%) of the 34, and regional lymph node status was accurately predicted in 28 (82%) of the 34. Of the patients with sonographic wall penetration, 80% had histologic evidence of one or more positive nodes. Using the WNM staging system, endoscopic ultrasonography correctly staged the cancer in 68% of the patients. Three patients were treated with an inappropriate procedure.

Conclusion:  Endosonography is a reliable method for the preoperative staging and selection of patients for curative or palliative resection. Endosonographic wall penetration appears to be a critical factor in determining tumor spread.(Arch Surg. 1994;129:534-539)