Practice Patterns of Surgical Therapy for Esophageal Cancer

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. 45.5% 66 Total Respondents   145 (skipped this question)   0

6. In what continent do you practice?   Response Percent Response 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