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Neoadjuvant chemotherapy regimens have been proven to decrease tumour size and stage and sig- nificantly improve progression-free and overall survival in the treatment of locoregional advanced gastroesophageal adenocarcinomas. Therefore, the pre-therapeutic staging of the tumour extension is of utmost importance for strat- ification of patients into this individualized therapy regimen. Within the last years most experience has been gained using endoscopic ultrasound (EUS) and it has been considered as a valuable tool for the assessment of locoregion- al disease. Aim: To evaluate the accuracy of endoscopic ultrasound for the preoperative staging of locally advanced gastroe- sophageal adenocarcinomas with regard to defining patients' eligibility for neoadjuvant chemotherapy. Material and methods: Between January 2006 and June 2007 consecutive patients (n = 47) who underwent resection of a gastroesophageal adenocarcinoma and would have been potentially eligible for neoadjuvant chemotherapy were included in this study. Preoperative EUS staging was compared to the postoperative histopathology results. Further- more, the specificity, sensitivity and positive and negative predictive values for serosal invasion and/or lymph node positivity as an eligibility criterion for neoadjuvant chemotherapy were evaluated. Results: Thirty-seven patients were included in the analysis with adenocarcinomas of the distal oesophagus (n = 7), the oesophagogastric junction (n = 8) and the stomach (n = 22). The overall accuracy for predicting the T stage was 64.9% (n = 24) with an over- and understaging of 13.5% (n = 5) and 21.6% (n = 8), respectively. The overall accuracy for predicting the N stage was 64.7% (n = 22), with an over- and understaging of 26.5% (n = 9) and 8.8% (n = 3). Twenty-five out of 37 patients would have met the eligibility criteria for enrolment in a neoadjuvant chemotherapy regimen. The sensitivity was 76% (n = 19/25). The specificity was 75% (n = 9/12). The positive predictive value was 86.4%. The negative predictive value was 60%. Conclusions: In this series the sensitivity and specificity of EUS for identification of patients eligible for neoadjuvant chemotherapy seem acceptable. Especially the positive predictive value, which expresses the probability that a patient identified by EUS as eligible for neoadjuvant chemotherapy met the corresponding histopathological criteria, was high (86.4%). Therefore, it seems justified to apply neoadjuvant chemotherapy in patients identified as eligible by EUS. This Original paper

videosurgery and other miniinvasive techniques/wideochirurgia i inne techniki mało inwazyjne

Endoscopic ultrasound in the pre-therapeutic staging of gastroesophageal adenocarcinoma: the diagnostic value in defining patients eligible for a neoadjuvant chemotherapy regimen