The use of Endoscopic Ultrasound as a staging investigation for Oesophago-Gastric cancer reduces the rate of R2 resections and open and close laparotomy

Aim:

To evaluate the effect of endoscopic ultrasound (EUS) in the staging of oesophago-gastric cancer patients, in terms of the proportion of patients that subsequently underwent an open and close laparotomy or R2 resection.

Method:

Prospectively collected data from 840 patients (511 oesophageal, 329 gastric) presenting from 1993 to 2004 were analysed. Sub-total gastrectomies were not included in the analysis, as they are occasionally undertaken with palliative intent. 437 patients underwent EUS as part of their staging regime. Results compared patients staged with or without EUS. Analysis with regard to the number of patients that underwent an open and close laparotomy or an R2 resection for all patients with oesophago-gastric cancer is presented.

Results:

The addition of EUS to the staging of oesophago-gastric cancer patients was associated with a significant reduction in the proportion of patients that underwent an open and close laparotomy or R2 resection (13.1% to 7.1% (p=0.004)) and (9.7% to5.0% (p=0.01)). Sub-group analysis for gastric cancer showed a reduction in the laparotomy only rate (16.9% to 7.1% (p=0.01)). No significant change was seen for R2 resections. Similar sub-group analysis for oesophageal cancer patients failed to demonstrate any effect with the addition of EUS.

Analysis of data following the introduction of helical CT scanning revealed the same pattern with a reduced laparotomy only rate seen for gastric cancer patients (36% vs. 8% (p=0.024))

Conclusions:

The inclusion of EUS in the staging protocol for gastric cancer significantly reduces the number of patients with potentially curable tumours who subsequently undergo an open and close laparotomy. No significant change was observed for oesophageal cancer.