Technique of extended diagnostic laparoscopy in the staging of cancer of the esophagus

Extended diagnostic laparoscopy is increasingly used in the preoperative staging of abdominal malignancies. In an ongoing prospective study, extended diagnostic laparoscopy was applied to patients with esophageal carcinoma referred for resection. After completion of the clinical staging, extended diagnostic laparoscopy was performed under general anesthesia, following a strict protocol, including inspection of all four quadrants of the abdomen, lavage cytology for free tumor cells, laparoscopic ultrasound, inspection of the lesser sac and taking of biopsies under visual control or guided by laparoscopic ultrasound. In our initial experience, extended diagnostic laparoscopy added substantial information to the tumor-staging in patients with adenocarcinoma of the lower esophagus while, in patients with squamous-cell carcinoma of the esophagus, the benefit of extended diagnostic laparoscopy was mainly limited to findings regarding the operability of the patient such as liver function.