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Rôle de l’endoscopie ultrasonographique dans la prévision de la résécabilité des cancers du tractus digestif supérieur

Treatment related assessment of resectability in upper GI cancer by endoscopic ultrasonography

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Résumé

L’évaluation correcte pré-thérapeutique de la résécabilité est un élément important du traitement des cancers du tractus digestif supérieur, contribue à la sélection de patients porteurs d’une lésion localisée résécable et permet d’éviter des laparotomies inutiles chez les patients aux lésions non résécables. Dans une étude prospective de 175 patients, nous avons évalué le rôle de l’ultrasonographie endoscopique pré-thérapeutique (USE) dans la prévision de la résécabilité de cancers œsophagien, gastrique et pancréatique. La comparaison avec les données opératoires (n=122) a montré la fiabilité du bilan de résécabilité par l’USE dans 88% des patients. Tous les patients chez qui une résection a pu être réalisée à titre palliatif ont été correctement identifiés par USE tandis que la sensibilité de l’USE à identifier les résections curatives variait de 86 à 100 %. La sensibilité de l’USE dans l’identification de tumeurs non résécables variait de 74 à 82%. Nos résultats suggèrent que l’USE pré-thérapeutique procure une haute précision dans la conduite du traitement du patient porteur d’un cancer œsophagien, gastrique ou pancréatique, mais que l’identification correcte des tumeurs non résécables n’est pas toujours possible par la seule USE.

Summary

A correct pretherapeutic assessment of resectability is important in upper GI tract cancer in order to subject only patients with localized disease to major surgery and to avoid futile laparotomies in non-resectable patients. The use of pretherapeutic endoscopic ultrasonography (EUS) for a treatment related assessment of resectability in esophageal, gastric and pancreatic cancer was prospectively evaluated in 175 patients. When compared with intraoperative findings (n=122) EUS made a correct treatment assessment of resectability in 88% of the patients. All patients in which a resection was possible but where it would be of a palliative nature were correctly identified, whereas the sensitivity of EUS to identify the curable patients varied from 86 to 100%. The sensitivity of EUS to identify the non-resectable patients varied from 74 to 82%. Our data suggest that pretherapeutic EUS provides a high accuracy in treatment guidance of esophageal, gastric and pancreatic cancer patients, but correct identification of the non-resectable patients is not always possible by EUS alone.

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Mortensen, M.B., Hovendal, C. Rôle de l’endoscopie ultrasonographique dans la prévision de la résécabilité des cancers du tractus digestif supérieur. Acta Endosc 25, 415 (1995). https://doi.org/10.1007/BF02966473

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Mots-clés

  • cancer du tractus digestif supérieur
  • endoscopie ultrasonographique
  • endosonographie à balayage électronique sectoriel
  • résécabilité
  • USE

Key-words

  • curved array endosonography
  • EUS
  • resectability
  • upper GI cancer