Endoscopic ultrasound compared with laparoscopy for staging esophageal cancer

Endoscopic ultrasonography (EUS) is an accurate modality for locoregional staging of esophageal cancer. Given an increasing prevalence of distal esophageal adenocarcinoma, some centers employ laparoscopic staging (LS) in addition to noninvasive staging methods. We sought to compare EUS and LS for nodal staging in patients with esophageal cancer.

All newly diagnosed, EUS-staged esophageal cancer cases during an 18-month period were reviewed. Patients who underwent both EUS and LS comprised the study cohort; EUS records, operative notes, and pathology reports were reviewed. Inability to pass the radial echoendoscope through the malignant stricture despite dilation was considered an incomplete EUS examination.

Forty-seven patients were identified who underwent both modalities for staging; of these, 70% had complete EUS evaluation. For nodal staging, EUS-fine-needle aspiration was 90% accurate as compared with LS. Overall, staging accuracy of EUS compared with LS was 72%. Accuracy was 76% for patients with complete EUS staging compared with 64% for patients with incomplete EUS examinations. Staging differences were mostly reflected in distant metastases detected at LS (17%).

Endoscopic ultrasonography is nearly as accurate as LS in nodal staging for esophageal cancer. The value of LS is accurate abdominal nodal staging and detection of occult distant metastases. Laparoscopic staging should, therefore, be incorporated into staging algorithms for neoadjuvant protocols. In the absence of preoperative therapy, LS should be performed at the time of planned esophagectomy. In those without occult metastases, curative resection may be attempted.