Patients and Methods

Between January 1989 and December 1994, 55 patients underwent EUS as part of their preoperative staging workup for carcinoma of the thoracic esophagus. Tumors were located in the lower third of the esophagus or gastroesophageal junction (GEJ) in 39 patients, middle esophagus in 13 and in the upper thoracic esophagus in three patients. Adenocarcinoma of the esophagus or GEJ was present in 36 patients while 19 had squamouscell carcinoma. EUS was performed by a single operator (HS) in 34 patients while the remaining patients were studied by several other physicians. EUS was performed with an Olympus GF-UM system (Olympus Corp., Lake Success, NY, USA). All patients underwent light intravenous sedation. The 13-mm radial scanner ultrasound echoendoscope was passed into the esophagus. Mural penetration was classified as T, if the tumor extended into but not through the submucosa (seen as the second hyperechoic layer), T₂ if the muscularis propria was partially invaded (second hypoechoic layer) and T₃ , if the last hyperechoic layer, the adventitia, was reached. Tumors were considered T₄, if clear invasion of the mediastinal structures was noted. Nodal metastasis, was assessed based on various parameters including nodal size, shape and echogenicity. Exact criteria for assessing nodal status varied among various operators. All patients subsequently underwent esophagectomy (54 transthoracic, one transhiatal) with radical lymphadenectomy excising all nodal stations between the tracheal bifurcation and the celiac axis (Table 1). Clinical and pathologic staging was done using the UICC/AJCC staging system (Table 2).

Table 1
Nodal groups resected at esophagectomy