The role of staging investigations for oesophago-gastric carcinoma

• Published in: European journal of surgical oncology 2004-04, Vol.30 (3), p.309-312
• Main Authors: Clements, D.M, Bowrey, D.J, Havard, T.J
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Clinical Protocols; Endoscopic ultrasound; Endosonography; Esophageal Neoplasms - diagnosis; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagectomy; Esophagogastric Junction; Female; Gastrectomy; Gastro-oesophageal junction; Humans; Laparoscopy; Male; Medical Audit; Middle Aged; Neoplasm Staging; Oesophageal cancer; Preoperative Care; Staging; Stomach cancer; Stomach Neoplasms - diagnosis; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2003.11.013

Aims. To study the frequency with which unresectable disease was identified on pre-operative staging investigations in patients with oesophago-gastric carcinoma, and to audit whether a staging protocol had reduced the rate of exploratory surgery. Methods. Ninety-eight patients with oesophageal carcinoma, 89 patients with adenocarcinoma of the gastro-oesophageal junction (GOJ) and 68 patients with gastric carcinoma were staged according to a protocol of computerised tomography, laparoscopy and endoscopic ultrasound. Results. The frequency with which each investigation identified unresectable disease was as follows: (a) computerised tomography—oesophagus 12/67, GOJ 13/58, stomach 10/60; (b) laparoscopy—oesophagus 3/22, GOJ 5/45, stomach 8/23; and (c) endoscopic ultrasound—oesophagus 15/55, GOJ 3/30. By tumour location, rates of exploratory surgery were 1/18 for the oesophagus, 12/35 for the GOJ and 4/42 for the stomach. All of the staging failures in patients with GOJ carcinomas related to posterior tumour extension into the lesser sac. Conclusions. Staging investigations precluded resection in one-third of patients, the greatest yield being for laparoscopy in gastric carcinoma. In spite of this, 18% of patients undergoing surgical intervention underwent exploratory surgery alone, notably patients with GOJ carcinoma.