Journal Article

Accuracy of preoperative staging for a priori resectable esophageal cancer

M Winiker, S Mantziari, S G Figueiredo, N Demartines, P Allemann and M Schäfer

in Diseases of the Esophagus

Published on behalf of International Society for Diseases of the Esophagus

Volume 31, issue 1 Published in print January 2018 | ISSN: 1120-8694
Published online September 2017 | e-ISSN: 1442-2050 | DOI:

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  • Clinical Medicine
  • Gastroenterology
  • Medical Oncology
  • Surgery
  • Gastro-intestinal and Colorectal Surgery


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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.

Keywords: esophageal cancer; esophagectomy; lymph nodes metastasis; neoadjuvant treatment; staging

Journal Article.  3802 words.  Illustrated.

Subjects: Clinical Medicine ; Gastroenterology ; Medical Oncology ; Surgery ; Gastro-intestinal and Colorectal Surgery