RESUMO
A new modality, intraoperative esophagoscopy [IOE], was evaluated and compared to other diagnostic tools for the assessment of the lower margin of hypophayngeal carcinoma and the esophagus distal to the lesion. This study was carried on 25 patients with hypophayngeal carcinoma obstructing the pharyngoesophageal junction on endoscopy. Assessment of the lower tumor margin and esophageal mucosa was done by barium swallow, CT scan, intraoperative esophagoscopy [IOE] and serial sectioning of the specimen after resection. It was found that barium swallow is more accurate than CT in deciding the level of the lower extent of the tumor, but both measures failed to give any data about the extent of submucosal spread, the presence of skipped lesions and/or second primary. On the other hand, sensitivity of IOE to detect mucosal and .submucosal tumor extension inferior to the macroscopic tumor margin was 95%and 80% respectively. By this method, the upper obstructing lesion was bypassed, and also the use of different angled telescopes allowed a better and magnified view of the mucosa below the macroscopic lower tumor margin. The use of Toluidine blue 1% permitted detection of mucosal spread, which augmented the value of IOE