Laparoscopy/thoracoscopy for staging: II. Pretherapy nodal evaluation in carcinoma of the esophagus

Many surgical studies show a significant stratification of survival following resection of esophageal cancer based upon accurate pathologic staging. However, investigators are moving away from single modality therapy toward multimodality trials for the treatment of this disease. This presents a problem in staging of patients before therapy is begun. Chemotherapy and/or radiation therapy may alter the local tumor characteristics and nodal metastases, thus confounding evaluation of treatment results. Although CT scanning and transesophageal ultrasound help in assessing nodal status, they have not reached the precision necessary for study purposes. Pretherapy nodal staging using video-assisted exploration may provide the same level of accuracy as mediastinoscopy does for lung cancer.