Worldwide trends in surgical techniques in the treatment of esophageal and gastroesophageal junction cancer

Abstract

The aim of this study was to evaluate the worldwide trends in surgical techniques for esophageal cancer surgery by comparing it to our survey from 2007. In addition, new questions were added for gastroesophageal junction (GEJ) cancer. An international survey on surgery of esophageal and GEJ cancer was performed among surgical members of the International Society for Diseases of the Esophagus, the World Organization for Specialized Studies on Disease of the Esophagus, the International Gastric Cancer Association. Also, surgeons from personal networks were contacted. The participants filled out a web based questionnaire about surgical strategies for esophageal and gastroesophageal cancer. The overall response rate was 478/1147 (42%). The respondents represented 49 different countries and 6 different continents. The annual cumulative number of esophageal and gastric resections per surgeon was low (≤11) in 11%, medium (11-21) in 17%, and high (≥21) in 72% of respondents. In a subgroup analysis of esophageal surgeons the number of high volume surgeons increased from 45 to 54% over the past 7 years. The preferred lymph node dissection was two-field in 86%. A gastric conduit was the preferred method of reconstruction in 95%. In 2014, the preferred approach to esophagectomy was minimally invasive transthoracic in 43%, compared with 14% in 2007. In minimally invasive transthoracic esophagectomy the cervical anastomosis was favored in 54% of respondents in 2014 compared with 87% in 2007. The preferred technique of construction of the cervical anastomosis was hand-sewn in 64% and stapled in 36%, whereas the thoracic anastomosis was stapled in 77% and hand-sewn in 23%. The preferred surgical approach for Siewert type 1 tumors (5-1 cm proximal of the GEJ) was esophagectomy in 93% of respondents, whereas 6% favored gastrectomy and 3% combined a distal esophagectomy with a proximal gastrectomy. For Siewert type 2 tumors (1-2 cm from the GEJ) an extended gastrectomy was favored by 66% of respondents, followed by esophagectomy in 27% and total gastrectomy in 7%. Siewert type 3 tumors (2-5 cm distal of the GEJ) were preferably treated with gastrectomy in 90% of respondents, esophagectomy in 6%, and extended gastrectomy in 4%. The preferred curative surgical treatment of esophageal cancer is minimally invasive transthoracic esophagectomy with a two-field lymph node dissection and gastric conduit reconstruction. A strong worldwide trend toward minimally invasive surgery is observed. The preferred surgical treatment of GEJ tumors is esophagectomy for Siewert type 1 tumors and gastrectomy for Siewert type 3 tumors. The majority of surgeons favor an extended gastrectomy for Siewert type 2 tumors.

McKeown or Ivor Lewis totally minimally invasive esophagectomy for cancer of the esophagus and gastroesophageal junction: systematic review and meta-analysis

“…Minimally invasive esophagectomy (MIE), consisting of hybrid minimally invasive esophagectomy (HMIE) or totally minimally invasive esophagectomy (TMIE), has been shown to be superior compared to open esophagectomy regarding perioperative outcome (3,4) without compromising oncologic safety (5,6). This has led to a progressive adoption of MIE and currently, 45% of all patients worldwide with resectable esophageal cancer undergo MIE (7).…”

“…It is currently unknown whether minimally invasive McKeown or minimally invasive Ivor Lewis esophagectomy should be preferred for these patients and both cervical and intrathoracic anastomoses are performed (7). The aim of this article is therefore to perform a systematic review and meta-analysis of studies comparing minimally invasive McKeown esophagectomy with minimally invasive Ivor Lewis esophagectomy.…”

Surgical treatment of esophageal cancer in the era of multimodality management

“…Traditional open esophagectomy (OE) is a highly invasive procedure that is associated with considerable morbidity . Over the last decades, minimally invasive techniques have been increasingly adopted for esophageal surgery . An important aim of minimally invasive surgery is to reduce the physiological stress response to trauma, which can in turn diminish postoperative immunosuppression and susceptibility to infections .…”

Recent management of esophago-gastric adenocarcinoma

“…Most of centers propose laparoscopic abdominal approach with gastric mobilization and pull up of the stomach through the diaphragmatic hiatus. Thoracic time is then performed open (Hybrid technique) [17].…”