gms | German Medical Science

Background: Preoperative endoscopy is decisive for surgical therapy in patients with resectable esophageal cancer. The objective of this retrospective study was to compare preoperative non-surgical (NSE) with surgical endoscopy (SE) with reference to parameters determining surgery.

Patients and Methods: 90 patients (male n=70, female n=20; age 63 years [28-85])) with esophageal cancer (squamous cell cancer n=29; adenocarcinoma n=61), 20 of which affected the cardia, underwent curative resection. All patients had undergone NSE upper gastrointestinal endoscopy before resection. Patients were reexamined by a team of surgical endoscopists. Level I parameters being crucially important for surgery were upper (UB) and lower border (LB) of cancer, hiatus, mucosal border between esophagus and cardia, measured in cm from the frontal dental line (FDL) as well as extent of barrett mucosa and upper esophageal sphincter in upper esophageal third cancer. Level II parameters were without operative relevance: grade of stenosis, circumferential extension, intraluminal growth pattern.

Results: Histological proof of cancer was achieved by 97% of NSE. The upper esophageal sphincter was described in 9% of SE but in no NSE. The UB of tumors was described in 97% of SE but only in 58% of NSE, the LB was quoted in 82% by SE and in 33% by NSE. The median difference between distance of UB and LB to the FDL was 1 cm [0-7] and 1 cm [0-6]. In 14% of patients stenoses made it impossible to determine LB. Localization of the esophago-cardial border was described in 72% of SE and in 8% of NSE. In 19% of SE this border was not described due to stenoses or overgrowth by tumor. Barrett mucosa was detected in 16% of SE and in 11% of NSE. Only 10% of NSE but 73% of SE described all level I parameters. Intraluminal growth pattern was quoted in 93% of SE and in 34% of NSE, in 8% there were discrepancies between SE and NSE. Stenoses were described in 41 (46%) tumors by SE. Twelve stenoses had not been described by NSE. Grade of stenosis was described in all patients by NSE and in with stenosing cancer.

Conclusions: SE is substantially more accurate than NSE in preoperative staging of esophageal cancer. While NSE is highly successful in histological verification of cancer, it fails to describe parameters crucially important for the operative procedure in most patients. As a consequence SE should be carried out in each patient in whom oncologic esophageal resection is intended by an experienced team.