Practice patterns of surgical therapy for esophageal cancer

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 PercentResponse 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 PercentResponse 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 PercentResponse 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 PercentResponse 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 PercentResponse 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.
45.5%66
Total Respondents  145
(skipped this question)  0
6. In what continent do you practice?
 Response PercentResponse Total
  North America
62.8%91
  Central/South America
4.1%6
  Europe
20%29
  Africa
0.7%1
  Asia
11.7%17
  Australia/New Zealand
0.7%1
Total Respondents  145
(skipped this question)  0

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 PercentResponse 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 PercentResponse 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 PercentResponse 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 PercentResponse 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 PercentResponse 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.
45.5%66
Total Respondents  145
(skipped this question)  0
6. In what continent do you practice?
 Response PercentResponse Total
  North America
62.8%91
  Central/South America
4.1%6
  Europe
20%29
  Africa
0.7%1
  Asia
11.7%17
  Australia/New Zealand
0.7%1
Total Respondents  145
(skipped this question)  0