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Mark J. Krasna
Xiaolong Jiao
Joshua R. Sonett
Ziv Gamliel
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Right arrow Esophagus - cancer

Ann Thorac Surg 2002;73:1710-1713
© 2002 The Society of Thoracic Surgeons

Original article: general thoracic

Thoracoscopic and laparoscopic lymph node staging in esophageal cancer: do clinicopathological factors affect the outcome?

Mark J. Krasna, MD*a, Xiaolong Jiao, MDa, Joshua R. Sonett, MDa, Ziv Gamliel, MDa, Afshin Eslami, MDa, Yael Raefaly, MDa, Yousheng Mao, MDa

a Division of Thoracic Surgery, University of Maryland Medical System, Baltimore, Maryland, USA

* Address reprint requests to Dr Krasna, Division of Thoracic Surgery, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201 USA
e-mail: mkrasna{at}smail.umaryland.edu

Presented at the Video Session of the Forty-eighth Annual Meeting of The Southern Thoracic Surgical Association, San Antonio, Texas, Nov 8–10, 2001.

Background. This study was performed to evaluate the pattern of lymphatic metastases found by combined thoracoscopic (TS) and laparoscopic (LS) lymph node staging in esophageal cancer, and ascertain whether clinicopathologic factors may be used to guide the clinical practice of combined TS and LS staging.

Methods. A retrospective study was performed in a series of 76 esophageal cancer patients who had undergone both TS and LS staging before treatment. The correlation of TS and LS lymph node metastases with clinicopathologic factors was analyzed, including the clinical T stage, clinical N stage, tumor location, and histology.

Results. Thirty-one patients (40.8%) were found to have lymphatic metastasis by TS and LS staging. Among them, 22 patients had abdominal lymph node metastases, 7 patients had mediastinal lymph node metastases, and 2 patients had both. Patients with advanced T stage (T3 to T4) or adenocarcinoma had a higher frequency of abdominal lymphatic metastases than patients with early T stage (T1 to T2) (39% vs 16%; p = 0.04) or squamous cell carcinoma (39% vs 20%; p = 0.079), respectively. Patients with clinical abdominal N1 stage had a higher incidence of positive laparoscopic finding than patients with clinical abdominal N0 stage (67% vs 23%; p = 0.001). There was no significant correlation between lymphatic metastases and the location of the primary tumor.

Conclusions. Clinicopathologic factors, including the histologic type, the clinical T stage, and abdominal N stage, may affect the outcome of TS and LS lymph node staging in esophageal cancer patients. This clinicopathologic impact may play a role for the selection of candidates for TS and LS staging, and also allows surgeons to focus their attention on the most likely high-yield biopsy targets.






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