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J Thorac Cardiovasc Surg 2007;133:323-324
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Discussion

Dr Steven G. Swisher (Houston, Tex). This study reviews the outcome of an uncommon subset of patients with esophageal cancer: those patients with clinical T2N0 tumors as defined by EUS. The authors make the observation that this group of patients seem to be difficult to accurately stage by EUS, with only 7 of 53 patients (13%) actually having a pathologic T2N0 tumor. Some 55% of the EUS-staged patients were overstaged and 32% were understaged, making proper treatment decisions difficult. The authors then evaluate the outcome of these patients and suggest that the optimal treatment for these patients is surgery first with postoperative chemoradiation reserved for those patients who have been understaged.

The article is to be commended for attempting to address an uncommon group of patients for whom little data are available and treatment decisions have not been defined. There are, however, several limitations to this study. It is retrospective and nonrandomized, and because of this, it is subject to bias and selection. This study was performed over a long period of time (20 years), with a small number of heterogeneous patients who were treated with several different treatment strategies. Because of these inherent limitations, accurate treatment assessments and recommendations are difficult to make even when performed with the aid of sophisticated statistical analyses.

I have several questions for the author. First, the accuracy of EUS staging for T2 esophageal cancers is much lower than that reported by recent groups who have used new EUS probes that operate at a higher frequency (15-20 MHz), as opposed to the 7.5 MHz described here, in which the esophageal wall can be visualized as a series of 7 or 9 layers. Would the use of these more accurate EUS miniprobes eliminate some of the staging inaccuracies reported in this study?

Dr . . . [Full Text of this Article]

Related Article

T2N0M0 esophageal cancer

Thomas W. Rice, David P. Mason, Sudish C. Murthy, Gregory Zuccaro, Jr, David J. Adelstein, Lisa A. Rybicki, and Eugene H. Blackstone
J. Thorac. Cardiovasc. Surg. 2007 133: 317-324. [Abstract] [Full Text] [PDF]