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.
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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? |
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Response Percent |
Response Total |
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Neoadjuvant chemotherapy +/- radiation therapy followed by resection. |
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72.4% |
105 |
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Resection followed by chemotherapy +/- radiation therapy, even if margins are clear (R0 resection). |
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19.3% |
28 |
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6.9% |
10 |
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Chemotherapy and radiation therapy only. |
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1.4% |
2 |
Total Respondents |
145 |
(skipped this question) |
0 |
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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? |
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Response Percent |
Response Total |
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Ivor Lewis esophagectomy (2-hole approach; high intrathoracic anastomosis) |
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35.9% |
52 |
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Modified Ivor Lewis esophagectomy (3-hole approach; cervical anastomosis) |
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15.9% |
23 |
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Transhiatal esophagectomy |
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22.1% |
32 |
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Left thoracotomy for resection and reconstruction |
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6.2% |
9 |
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Thoracoabdominal approach for resection and reconstruction |
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8.3% |
12 |
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Minimally invasive or hybrid esophagectomy |
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11% |
16 |
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0.7% |
1 |
Total Respondents |
145 |
(skipped this question) |
0 |
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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? |
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Response Percent |
Response Total |
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Ivor Lewis esophagectomy (2-hole approach; high intrathoracic anastomosis) |
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33.1% |
48 |
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Modified Ivor Lewis esophagectomy (3-hole approach; cervical anastomosis) |
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20.7% |
30 |
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Transhiatal esophagectomy |
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18.6% |
27 |
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Left thoracotomy for resection and reconstruction |
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9% |
13 |
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Thoracoabdominal approach for resection and reconstruction |
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7.6% |
11 |
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Minimally invasive or hybrid esophagectomy |
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10.3% |
15 |
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0.7% |
1 |
Total Respondents |
145 |
(skipped this question) |
0 |
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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? |
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Response Percent |
Response Total |
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No, I proceed with resection whether or not persistent disease is identified. |
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87.6% |
127 |
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Yes, resection is contraindicated unless persistent disease is identified. |
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5.5% |
8 |
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Yes, identification of persistent disease is a contraindication to resection. |
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6.9% |
10 |
Total Respondents |
145 |
(skipped this question) |
0 |
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5. Do you participate directly in the decision to offer neoadjuvant therapy to patients with a T2N1M0 distal thoracic adenocarcinoma? |
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Response Percent |
Response Total |
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Usually not, the decision is typically made prior to my seeing such patients. |
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7.6% |
11 |
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Usually not, the treatment has usually been completed prior to my seeing such patients. |
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4.8% |
7 |
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Usually yes, these patients are reviewed with me by referring oncologists. |
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42.1% |
61 |
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Usually yes, these patients are discussed in a multidisciplinary conference prior to beginning therapy. |
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45.5% |
66 |
Total Respondents |
145 |
(skipped this question) |
0 |
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6. In what continent do you practice? |
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Response Percent |
Response Total |
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62.8% |
91 |
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4.1% |
6 |
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20% |
29 |
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0.7% |
1 |
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11.7% |
17 |
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0.7% |
1 |
Total Respondents |
145 |
(skipped this question) |
0 |
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