Bronchoscopic Staging Of Esophageal Carcinoma After Neoadjuvant Chemoradio-Therapy

Bronchoscopy is a valuable tool in staging patients with esophageal carcinoma. Compression of tracheobronchial tree at bronchoscopy does not necessarily mean neoplastic infiltration. If the mass is mobile during breathing and coughing a radical surgical resection possible. Conversely, rigid protrusion and mucosal irregularities have been considered indicators of tumor infiltration.Between November 1, 1992 and October 30, 1999, 72 patients with supracarinal esophageal carcinoma previously treated with chemoradiotherapy (CRT) underwent videobronchoscopy as part of the preoperative staging. Nine patients with rigid protrusion at bronchoscopy after CRT were operated on, and in 3 of them a radical resection was possible.CRT does not impair the predictive value of bronchoscopy if the findings are normal or there is a mobile protrusion. However, rigid protrusion could be due to post-CRT fibrosis and not to tumor invasion; a radical surgical resection is still possible in one third of these patients. Pre CRT bronchoscopic stage and imaging techniques (CT, MR) should be considered in an integrated fashion when planning a radical esophagectomy.