Accuracy of preoperative staging for a priori resectable esophageal cancer

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.