Practice patterns of surgical therapy for esophageal cancer
This esophageal cancer management survey was posted during the months of August and September 2006.
A total of 145 responses were received, the majority of which were from North American participants.
Most surgeons recommend induction therapy prior to resection for regionally advanced esophageal cancer. It is interesting to note that over 85% of surgeons felt that they had input into this decision prior to the institution of therapy.
Resections were performed primarily using open techniques involving a right thoracotomy, but there were at least 4 other techniques that were used with some meaningful frequency.
About 10% of resections are being performed minimally invasively; this may reflect the specific interests of the respondents rather than representing a general trend towards minimally invasive surgery for this condition.
1. A patient has a T2N1M0 adenocarcinoma of the distal thoracic esophagus. He is a satisfactory risk for esophagectomy. What is your preference for therapy?
Response Percent
Response Total
Neoadjuvant chemotherapy +/- radiation therapy followed by resection.
72.4%
105
Resection followed by chemotherapy +/- radiation therapy, even if margins are clear (R0 resection).
19.3%
28
Resection only.
6.9%
10
Chemotherapy and radiation therapy only.
1.4%
2
Total Respondents
145
(skipped this question)
0
2. A patient has a T2N1M0 adenocarcinoma of the distal thoracic esophagus. He is a satisfactory risk for esophagectomy. He has not received prior therapy. What is your preferred surgical approach to resection?
Response Percent
Response Total
Ivor Lewis esophagectomy (2-hole approach; high intrathoracic anastomosis)
35.9%
52
Modified Ivor Lewis esophagectomy (3-hole approach; cervical anastomosis)
15.9%
23
Transhiatal esophagectomy
22.1%
32
Left thoracotomy for resection and reconstruction
6.2%
9
Thoracoabdominal approach for resection and reconstruction
8.3%
12
Minimally invasive or hybrid esophagectomy
11%
16
Other
0.7%
1
Total Respondents
145
(skipped this question)
0
3. A patient has a T2N1M0 adenocarcinoma of the distal thoracic esophagus. He is a satisfactory risk for esophagectomy. He has received prior therapy including two cycles of 5-FU and cisplatin as well as 50 Gy of radiation therapy, both having been completed 1 month prior to the planned resection. What is your preferred surgical approach to resection?
Response Percent
Response Total
Ivor Lewis esophagectomy (2-hole approach; high intrathoracic anastomosis)
33.1%
48
Modified Ivor Lewis esophagectomy (3-hole approach; cervical anastomosis)
20.7%
30
Transhiatal esophagectomy
18.6%
27
Left thoracotomy for resection and reconstruction
9%
13
Thoracoabdominal approach for resection and reconstruction
7.6%
11
Minimally invasive or hybrid esophagectomy
10.3%
15
Other
0.7%
1
Total Respondents
145
(skipped this question)
0
4. Assuming that disease progression has not been documented, does the disease status after neoadjuvant therapy influence your decision to proceed with esophagectomy for a distal thoracic adenocarcinoma originally staged T2N1M0?
Response Percent
Response Total
No, I proceed with resection whether or not persistent disease is identified.
87.6%
127
Yes, resection is contraindicated unless persistent disease is identified.
5.5%
8
Yes, identification of persistent disease is a contraindication to resection.
6.9%
10
Total Respondents
145
(skipped this question)
0
5. Do you participate directly in the decision to offer neoadjuvant therapy to patients with a T2N1M0 distal thoracic adenocarcinoma?
Response Percent
Response Total
Usually not, the decision is typically made prior to my seeing such patients.
7.6%
11
Usually not, the treatment has usually been completed prior to my seeing such patients.
4.8%
7
Usually yes, these patients are reviewed with me by referring oncologists.
42.1%
61
Usually yes, these patients are discussed in a multidisciplinary conference prior to beginning therapy.
