Potential impact of FDG PET/CT on surgical approach and lymphadenectomy in esophagectomy for middle to lower thoracic esophageal cancer

Abstract

14692 Background: The optimal extent of lymphadenectomy in radical esophagectomy remains controversial. FDG PET was reported to gain advantages over conventional work-up in detecting lymphatic metastasis. The purpose of this study was to investigate the potential role of pre-operative PET/CT on transthoracic approach and lymphadenectomy in the surgical treatment of esophageal cancer. Methods: A prospective study was conducted in patients with resectable squamous cell cancer at middle to lower thoracic esophagus between September 2003 and June 2006. Patients were randomized into two groups. 49 cases underwent pre-operative FDG PET/CT and the results of the scan could be used as a guide for determining transthoracic approach and lymphadenectomy; whereas 47 cases serving as control underwent conventional operation. The surgical data and long-term results in terms of lymphadenectomy were compared between the two groups. Results: Based on PET/CT findings, three patients were not subjected to operation, the surgical approach related to thoracotomy had to be altered for another six cases. Operative morbidity and mortality were similar in both groups. PET/CT displayed a high sensitivity (91.5%) and accuracy (89.7%) in detecting lymphatic metastasis. It allowed to remove more invaded lymph nodes compared with the control group, the percentage of metastatic nodes was 34.8% in PET/CT group, versus 17.1% in the control group (P = 0.023). The two- year survival rate was estimated as 57.9% for PET/CT group, versus 55.0% for the control group. The Kaplan-Meier analysis indicated no significant difference (P = 0.685). However, PET/CT group was related to a prolonged disease-free survival in comparison with the control group, the estimated median disease-free survival of the former was significantly higher than the latter (26.3months vs. 17.1months; P = 0.038). Conclusions: Owing to the high sensitivity and accuracy in detecting nodal metastasis for esophageal cancer, pre- operative PET/CT allows more precisely localizing metastatic lesions, it increases the likelihood of complete resecion and affects patients’ disease-free survival. It would be applicable to use PET/CT as a tool to aid in the surgical treatment of patients with esophageal cancer. No significant financial relationships to disclose.