Mark J. Krasna*, Carolyn E. Reed*, David J. Sugarbaker*, James D. Luketich, Malcolm DeCamp, Jr., Robert Mayer, Donna Hollis and CALGB Surgeons

University of Maryland, Medical University of South Carolina, Dana Farber Cancer Institute, University of Pittsburgh, Cleveland Clinic, CALGB Statistical Center

The staging of esophageal cancer is imprecise. Thoracoscopic/laparoscopic (TS/LS) staging has been proposed as a more accurate staging method. We report the experience of an Intergroup NCI trial (CALGB 9380) evaluating the feasibility and accuracy of this staging modality.

From February 1995 to February 1999, 82 patients were entered into the study (four ineligible). TS/LS was considered feasible if at least three lymph nodes (LN) were sampled by TS and one LN by LS; a confirmed positive node was found; or T4M1 disease was documented. The LN stations most frequently sampled in the thorax (82 pts) were levels 2 (32%), 3 (34%), 4 (38%), 7 (56%), 8 (54%), 9 (39%), and 10 (30%), and in the abdomen, levels 17 (49%) and 20 (43%). Noninvasive tests (CT, MRI, EUS) failed to detect 28/70 (40%) positive LN identified by TS/LS. Median operation time was 206.5 min (range 45-673). Median postoperative hospital stay was 3 days.

There were no deaths or major complications. Sixty-four patients met the definition for feasibility. In 14 patients TS was not feasible. Positive LN disease was found in 32; 23 were deemed N0. Nine patients had T4/M1 disease. Of the 23 potentially resectable N0 patients, 15 patients had preoperative induction therapy; 8 patients went directly to surgery with N0 confirmed in 5, NX in 1 and N1 in 2.

In summary, the feasibility of TS/LS was confirmed. It doubled the number of positive lymph nodes identified by conventional noninvasive staging. Although the positive predictive value was high, further studies are needed to confirm the role of TS/LS in the staging algorithm of esophageal cancer.