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Evaluation of minimally invasive surgical staging for esophageal cancer

Authors
  • Nguyen, Ninh T
  • Roberts, Peter F
  • Follette, David M
  • Lau, Derek
  • Lee, John
  • Urayama, Shiro
  • Wolfe, Bruce M
  • Goodnight, James E Jr
Type
Published Article
Journal
The American Journal of Surgery
Publisher
Elsevier
Publication Date
Jan 01, 2002
Volume
182
Issue
6
Pages
702–706
Identifiers
DOI: 10.1016/S0002-9610(01)00804-2
Source
Elsevier
Keywords
License
Unknown

Abstract

Background: Conventional imaging studies (computed tomography and endoscopic esophageal ultrasonography) used for preoperative evaluation of patients with esophageal cancer can be inaccurate for detection of small metastatic deposits. We evaluated the efficacy of minimally invasive surgical (MIS) staging as an additional modality for evaluation of patients with esophageal cancer. Methods: Between December 1998 and February 2001, 33 patients with esophageal cancer were evaluated for surgical resection. Conventional imaging studies demonstrated operable disease in 31 patients and equivocal findings in 2 patients. All patients then underwent MIS staging (laparoscopy, bronchoscopy, and ultrasonography of the liver). We compared the results from surgical resection and MIS staging with those from conventional imaging. Results: MIS staging altered the treatment plan in 12 (36%) of 33 patients; MIS staging upstaged 10 patients with operable disease and downstaged 2 patients with equivocal findings. MIS staging accurately determined resectability in 97% of patients compared with 61% of patients staged by conventional imaging. The specificity and negative predictive value for detection of unsuspected metastatic disease in MIS staging were 100% and 96%, respectively, compared with 91% and 65%, respectively, for conventional imaging studies. Conclusion: In addition to conventional imaging studies, MIS staging should be included routinely in the preoperative work-up of patients with esophageal cancer.

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