The role of thoracoscopic lymph node staging in esophageal cancer

Background. Unlike mediastinoscopy in lung cancer, there exists no standard minimally invasive test to stage esophageal cancer, If it were possible to obtain exact preoperative staging in esophageal cancer, patients could be separated prospectively to receive adjuvant therapy appropriately, Methods. We studied the feasibility and efficacy of thoracoscopic lymph node staging (TSLN) and laparoscopic lymph node staging (LSLN) in esophageal cancer, Results, TSLN was performed in 45 patients with biopsy proven carcinoma of the esophagus. LSLN was done in the last 19 patients, TSLN was aborted in 3 pts due to adhesions, Thoracic LN stage was NO in 39 patients and NI in 3; celiac LN were negative in 13 and positive in 6 patients, Esophageal resection was performed in 30 patients after TSLN; 17 of these underwent LSLN, TSLN staging showed NO lymph node status in 28 patients and N1 in 2 patients, Two of the 28 NO patients (7%) were found at resection to have paraesophageal lymph node involvement (N1) and were thus understaged by TSLN. Thus TSLN was accurate in detecting the presence of thoracic LN in 28/30 cases (93%). LSLN staging found negative celiac nodes in 12 patients and positive LN in 5 patients, After esophagectomy, final pathology of the 12 NO patients was NO in 11 and positive LN in one patient, Thus, LSLN was accurate in detecting lymph node metastases in 16/17 patients (94%).