Recurrence after Esophagectomy for Adenocarcinoma: Defining Optimal Follow-Up Intervals and Testing

Abate, Emmanuele; DeMeester, Steven R.; Zehetner, Joerg; Oezcelik, Arzu; Ayazi, Shahin; Costales, Jesse L.; Banki, Farzaneh; Lipham, John C.; Hagen, Jeffrey A.; DeMeester, Tom R.

doi:10.1016/j.jamcollsurg.2010.01.006

Cited by 162 publications

(167 citation statements)

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“…2,3,10) Depending on the type, stage, and treatment, at least 80% of recurrences have occurred by 21-38 months postoperatively. 2,5,10) In a 2010 review article, most centers supported an initial 4-to 6-week postoperative review, with follow-up 3 monthly in the first year, 6 monthly in the second year, and annually thereafter. 2) Length of follow-up in published guidelines and literature is poorly defined, but most support follow-up for at least 5 years.…”

Section: Discussionmentioning

confidence: 99%

“…2) Length of follow-up in published guidelines and literature is poorly defined, but most support follow-up for at least 5 years. 2,3,5) The Australian guidelines recommend 3 monthly follow-up for 2 years and then 6 monthly clinical follow-up to 5 years, with scope for longer follow-up if clinically indicated. 7) Although clinical information in our survey did have some impact on views regarding imaging, none of the scenarios showed clear consensus on whether routine imaging was appropriate or not.…”

Section: Discussionmentioning

confidence: 99%

“…5) Several published guidelines have been developed around the world, including the Scottish Intercollegiate Guidelines Network (SIGN), the British Society of Gastroenterology 2011, the European Society of Medical Oncology, the National Comprehensive Cancer Network (NCCN) 2009 3,4,6) and in Australia, the "Optimal Care Pathway for People with Oesophagogastric Cancer" has recently been published and endorsed by Government Health Departments. 7) In regard to recommendations for follow-up, all these guidelines agree that evidence in this area is lacking, [3][4][5][6][7] in particular due to a lack of evidence for any associated survival advantage with radiological or endoscopic surveillance. 8) The purpose of this study was to identify the views of surgeons and oncologists in Australia and New Zealand about follow-up practices after esophagogastric cancer resection, and to determine whether any consensus currently exists.…”

Section: Introductionmentioning

confidence: 99%

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Follow-Up Practices of Surgeons and Medical Oncologists in Australia and New Zealand Following Resection of Esophagogastric Cancers

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Section: Discussionmentioning

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Section: Discussionmentioning

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Section: Introductionmentioning

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Follow-Up Practices of Surgeons and Medical Oncologists in Australia and New Zealand Following Resection of Esophagogastric Cancers

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“…Locoregional recurrence or a combination of locoregional and distant recurrence occur less frequently (14% and 35%, respectively) (7). After recurrent esophageal cancer is diagnosed, poor median survival rates of 3-9 mo have been reported (8).…”

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confidence: 99%

Diagnostic Performance of ¹⁸F-FDG PET and PET/CT for the Detection of Recurrent Esophageal Cancer After Treatment with Curative Intent: A Systematic Review and Meta-Analysis

et al. 2015

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The aim of this study was to assess the diagnostic performance of 18 F-FDG PET and integrated 18 F-FDG PET/CT for diagnosing recurrent esophageal cancer after initial treatment with curative intent. Methods: The PubMed, Embase, and Cochrane library were systematically searched for all relevant literature using the key words " 18 F-FDG PET" and "esophageal cancer" and synonyms. Studies examining the diagnostic value of 18 F-FDG PET or integrated 18 F-FDG PET/CT, either in routine clinical follow-up or in symptomatic patients in whom recurrence of esophageal cancer was suspected, were deemed eligible for inclusion. The primary outcome was the presence of recurrent esophageal cancer as determined by histopathologic biopsy or clinical follow-up. Risk of bias and applicability concerns were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Sensitivities and specificities of individual studies were meta-analyzed using bivariate randomeffects models. Results: Eight eligible studies were included for meta-analysis, comprising 486 patients with esophageal cancer who underwent 18 F-FDG PET or PET/CT after previous treatment with curative intent. The quality of the included studies assessed by the QUADAS-2 tool was considered reasonable; there were few concerns with regard to the risk of bias and applicability. Integrated 18 F-FDG PET/CT and standalone 18 F-FDG PET were used in 4 and 3 studies, respectively. One other study analyzed both modalities separately. In 4 studies, 18 F-FDG PET or PET/CT was performed as part of routine follow-up, whereas in 4 other studies the diagnostic test was performed on indication during clinical follow-up. Pooled estimates of sensitivity and specificity for 18 F-FDG PET and PET/CT in diagnosing recurrent esophageal cancer were 96% (95% confidence interval, 93%-97%) and 78% (95% confidence interval, 66%-86%), respectively. Subgroup analysis revealed no statistically significant difference in diagnostic accuracy according to type of PET scanner (standalone PET vs. integrated PET/CT) or indication of scanning (routine follow-up vs. on indication). Conclusion: 18 F-FDG PET and PET/CT are reliable imaging modalities with a high sensitivity and moderate specificity for detecting recurrent esophageal cancer after treatment with curative intent. The use of 18 F-FDG PET or PET/CT particularly allows for a minimal false-negative rate. However, histopathologic confirmation of 18 F-FDG PET-or PET/CTsuspected lesions remains required, because a considerable falsepositive rate is noticed.

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“…10-20% of GEJ tumors are potentially resectable and systemic recurrence is detected in 70% despite curative surgery (13). For this reason, adjuvant, neoadjuvant chemotherapy, and chemoradiotherapy have been considered as part of treatment (14).…”

Section: Resultsmentioning

confidence: 99%

The clinicopathologic characteristics and prognostic factors of gastroesophageal junction tumors according to Siewert classification

et al. 2017

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INTRODUCTIONThe incidence of gastroesophageal junction (GEJ) tumors has been on a rapid upsurge in Western societies (1). Adenocarcinomas are the most frequent type within these tumors (2). Despite multimodality treatment, their prognosis is still poor with a 5-year survival rate of around 20% (1). The issue whether they should be treated like esophageal tumors or gastric tumors remains controversial due to their location. Siewert classified these tumors into three groups according to their anatomical locations in 1996 (3). By definition, all of these tumors invade the GEJ. The classification was revised in 2000, and type I tumors were defined as tumors within 1-5 cm above the GEJ, type II those within 1 cm above and 2 cm below the GEJ, and type III as tumors extending 2-5 cm below the GEJ (4). This classification is clinical and is based on barium study, endoscopy, computed tomography, and intraoperative evaluation findings (5). Type I tumors are distal esophageal tumors, type II tumors are true cardiac tumors, while type III tumors are subcardial gastric tumors. R0 resection is the most important determinant of long-term survival in GEJ tumors (6). The 5-year overall survival (OS) after R0 resection has been reported as 43.2%, and those of R1 and R2 resection as 11.1% and 6.2%, respectively (7). While Siewert I and II lesions are treated like esophageal tumors, Siewert III tumors are treated like gastric cancer (1). Due to screening and treatment of Barrett's esophagus, Siewert I tumors can be diagnosed at an early stage. Lymph node metastasis is another important predictor of survival, with a decrease from 53% to 11% in 5-year OS in case of presence of lymph node metastasis (8). For this reason, lymph node dissection should be included to surgery. The rate of lymph node metastasis increases from 10% to 67% in tumors with submucosal infiltration (9). The standard surgical treatment is subtotal esophagectomy and proximal gastrectomy with the exception of endoscopic treatment at a very early stage (10, 11). Distal esophagectomy and total gastrectomy are preferred in type II tumors (10, 11). The standard surgical approach in type III tumors is total gastrectomy and D1 lymph node dissection (12). Objective: The treatment of gastroesophageal junction tumors remains controversial due to confusion on whether they should be considered as primary esophageal or as gastric tumors. The incidence of these tumors with poor prognosis has increased, thus creating scientific interest on gastroesophageal cancers. Esophagogastric cancers are classified according to their location by Siewert, and the treatment of each type varies. We evaluated the prognostic factors and differences in clinicopathologic factors of patients with gastroesophageal junction tumor, who have been treated and followed-up in our clinics. Material and Methods:We retrospectively analyzed 187 patients with gastroesophageal junction tumors who have been operated and treated in the Oncology Department between 2005 and 2014. The chi-square test was used to eval...

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Recurrence after Esophagectomy for Adenocarcinoma: Defining Optimal Follow-Up Intervals and Testing

Cited by 162 publications

References 5 publications

Follow-Up Practices of Surgeons and Medical Oncologists in Australia and New Zealand Following Resection of Esophagogastric Cancers

Follow-Up Practices of Surgeons and Medical Oncologists in Australia and New Zealand Following Resection of Esophagogastric Cancers

Diagnostic Performance of ¹⁸F-FDG PET and PET/CT for the Detection of Recurrent Esophageal Cancer After Treatment with Curative Intent: A Systematic Review and Meta-Analysis

The clinicopathologic characteristics and prognostic factors of gastroesophageal junction tumors according to Siewert classification

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Recurrence after Esophagectomy for Adenocarcinoma: Defining Optimal Follow-Up Intervals and Testing

Cited by 162 publications

References 5 publications

Follow-Up Practices of Surgeons and Medical Oncologists in Australia and New Zealand Following Resection of Esophagogastric Cancers

Follow-Up Practices of Surgeons and Medical Oncologists in Australia and New Zealand Following Resection of Esophagogastric Cancers

Diagnostic Performance of 18F-FDG PET and PET/CT for the Detection of Recurrent Esophageal Cancer After Treatment with Curative Intent: A Systematic Review and Meta-Analysis

The clinicopathologic characteristics and prognostic factors of gastroesophageal junction tumors according to Siewert classification

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Diagnostic Performance of ¹⁸F-FDG PET and PET/CT for the Detection of Recurrent Esophageal Cancer After Treatment with Curative Intent: A Systematic Review and Meta-Analysis