CT evaluation of patients undergoing transhiatal esophagectomy for cancer.

Preoperative CT of 50 patients undergoing transhiatal esophagectomy for esophageal carcinoma was reviewed and compared with the surgical and histopathologic findings. Computed tomography was highly accurate in identifying those cases in which blunt esophagectomy was impossible owing to involvement of the airways or the aorta by the tumor. Preoperative detection of such involvement is important, because tumors of the upper thoracic esophagus are poorly visualized at transhiatal esophagectomy, and sharp or forced blunt dissection may result in accidental laceration of the trachea, mainstem bronchi, or aorta. In contrast, CT was of little value for guiding surgical management of tumors located in the middle thoracic and lower esophagus. Using the staging criteria of the International Union Against Cancer (UICC), the staging accuracy of CT was limited by its low sensitivity in detecting abdominal lymph node metastases.