Accuracy of preoperative staging for a priori resectable esophageal cancer

• Published in: Diseases of the esophagus 2018-01, Vol.31 (1), p.1-6
• Main Authors: Winiker, M, Mantziari, S, Figueiredo, S G, Demartines, N, Allemann, P, Schäfer, M
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Aged; Biopsy - methods; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Endosonography - methods; Esophageal Neoplasms - diagnostic imaging; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagectomy; Esophagus - diagnostic imaging; Esophagus - pathology; Female; Humans; Male; Middle Aged; Neoplasm Staging - methods; Neoplasm Staging - statistics & numerical data; Positron Emission Tomography Computed Tomography - methods; Predictive Value of Tests; Preoperative Care - methods; Prospective Studies; Retrospective Studies; Tomography, X-Ray Computed - methods
• ISSN: 1120-8694; 1442-2050
• DOI: 10.1093/dote/dox113

Summary This study assessed the accuracy of preoperative staging in patients undergoing oncological esophagectomy for adenocarcinoma and squamous cell carcinoma. All patients undergoing surgery for resectable esophageal cancer in a university hospital from 2005 to 2016 were identified from our institutional database. Patients with neoadjuvant treatment were excluded to avoid bias from down-staging effects. Routinely, all patients had an upper endoscopy with biopsy, a thoracoabdominal CT scan, an 18-FEG PET-CT, and endoscopic ultrasound. Preoperative staging was compared to histopathological staging of surgical specimen that was considered as gold standard. There were 51 patients with a median age of 65 years (IQR: 59.3–73 years) having 21 squamous cell carcinoma and 30 adenocarcinoma, respectively. T- and N-stages were correctly predicted in 26 (51%) and 37 patients (72%), respectively. Overall, 18 patients (35%) were preoperatively diagnosed with a correct T- and N-stage. There was no difference between adenocarcinoma and squamous cell carcinoma. Accuracy of the T-stage was not influenced by the smoking status. The N-stage was not correct in 7/22 smoking patients (32%) and 6/29 nonsmoking patients (21%).The N-stage was underestimated in smoking patients as 6/22 patients (27%) had a histologically confirmed N+ who were preoperatively classified as N0. In conclusion, only 35% of patients had a correct assessment. Separate T- and N-stage prediction was improved with 51% and 72%, respectively. Major efforts are needed for improvement.