Immediate preoperative laparoscopic staging for squamous cell carcinoma of the esophagus

• Published in: Surgical endoscopy Vol. 20; no. 2; pp. 307 - 310
• Main Authors: YAU, K. K, SIU, W. T, CHEUNG, H. Y. S, LI, A. C. N, YANG, G. P. C, LI, M. K. W
• Format: Journal Article
• Language: English
• Published: New York, NY Springer 01.02.2006; Springer Nature B.V
• Subjects: Abdomen; Aged; Biological and medical sciences; Biopsy; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Digestive system. Abdomen; Disease; Endoscopy; Esophageal cancer; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagectomy; Esophagoscopy; Esophagus; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hospitals; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Laparotomy; Lymphatic system; Male; Medical sciences; Metastasis; Middle Aged; Neoplasm Staging - methods; Ostomy; Patients; Preoperative Care; Retrospective Studies; Sensitivity and Specificity; Tumors; Ultrasonic imaging; Hong Kong China; China; Staging; Esophageal disease; Esophagus squamous cell carcinoma; Digestive diseases; Laparoscopy; Malignant tumor; Endoscopy; Preoperative; Esophagus cancer; Esophageal cancer
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-005-0336-x

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. 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. 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). 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.