For advanced carcinomas of the esophagus multimodal therapies consisting of neoadjuvant treatment with chemo- and/or radiation followed by surgical resection are the standard of care in western countries. Still unknown remains the question if clinical full responders to neoadjuvant treatment should receive an esophagectomy with all its perioperative risks as they could be pathological full responders potentially without further oncologic benefit. In this article we discuss the possible benefits and disadvantages of an organ sparing approach in comparison of the standard of care for patients with esophageal cancer.
FerlayJSoerjomataramIDikshitR, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359-E386. doi:10.1002/ijc.29210
2.
MoehlerMBaltinCTEbertM, et al. International comparison of the German evidence-based s3-guidelines on the diagnosis and multimodal treatment of early and locally advanced gastric cancer, including adenocarcinoma of the lower esophagus. Gastric Cancer. 2015;18(3):550-563. doi:10.1007/s10120-014-0403-x
3.
SongZWuYYangJYangDFangX.Progress in the treatment of advanced gastric cancer. Tumour Biol. 2017;39(7):1010428317714626. doi:10.1177/1010428317714626
4.
WilkeHLordickFMeyerHJStahlM.(Neo)-adjuvant chemo(-radio) therapy for adenocarcinomas of the gastroesophageal junction and the stomach in the West. Dig Surg. 2013;30(2):112-118. doi:10.1159/000350935
5.
CunninghamDAllumWHStenningSP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355(1):11-20. doi:10.1056/NEJMoa055531
6.
van HagenPHulshofMCvan LanschotJJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366(22):2074-2084. doi:10.1056/NEJMoa1112088
7.
Al-BatranSEHomannNPauligkC, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019;393(10184):1948-1957. doi:10.1016/S0140-6736(18)32557-1
8.
ShapiroJvan LanschotJJBHulshofMCCM, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol. 2015;16(9):1090-1098. doi:10.1016/S1470-2045(15)00040-6
9.
StahlMMarietteCHaustermansKCervantesAArnoldD. ESMO Guidelines Working Group. Oesophageal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(Suppl 6):vi51-vi56. doi:10.1093/annonc/mdt342
10.
TaketaTXiaoLSudoK, et al. Propensity-based matching between esophagogastric cancer patients who had surgery and who declined surgery after preoperative chemoradiation. Oncology. 2013;85(2):95-99. doi:10.1159/000351999
11.
LowDEKuppusamyMKAldersonD, et al. Benchmarkingomplications associated with esophagectomy. Ann Surg. 2019;269(2):291-298. doi:10.1097/SLA.0000000000002611
12.
DindoDDemartinesNClavienPA.Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-213. doi:10.1097/01.sla.0000133083.54934.ae
13.
NoordmanBJWijnhovenBPLLagardeSM, et al. Neoadjuvant chemoradiotherapy plus surgery versus active surveillance for oesophageal cancer: a stepped-wedge cluster randomised trial. BMC Cancer. 2018;18(1):142. doi:10.1186/s12885-018-4034-1
14.
NoordmanBJde Bekker-GrobEWCoenePPLO, et al. Patients’ preferences for treatment after neoadjuvant chemoradiotherapy for oesophageal cancer. Br J Surg. 2018;105(12):1630-1638. doi:10.1002/bjs.10897
15.
ViklundPWengströmYRouvelasILindbladMLagergrenJ.Quality of life and persisting symptoms after oesophageal cancer surgery. Eur J Cancer. 2006;42(10):1407-1414. doi:10.1016/j.ejca.2006.02.005
16.
ZierenHUJacobiCAZierenJMüllerJM.Quality of life following resection of oesophageal carcinoma. Br J Surg. 1996;83(12):1772-1775. doi:10.1002/bjs.1800831235
17.
LagergrenPAveryKNHughesR, et al. Health-related quality of life among patients cured by surgery for esophageal cancer. Cancer. 2007;110(3):686-693. doi:10.1002/cncr.22833
18.
MitchellKGNelsonDBCorsiniEM, et al. Morbidity following salvage esophagectomy for squamous cell carcinoma: the MD Anderson experience. Dis Esophagus. 2020;33(3):doz067. doi:10.1093/dote/doz067
19.
CheedellaNKSuzukiAXiaoL, et al. Association between clinical complete response and pathological complete response after preoperative chemoradiation in patients with gastroesophageal cancer: analysis in a large cohort. Ann Oncol. 2013;24(5):1262-1266. doi:10.1093/annonc/mds617
20.
NoordmanBJSpaanderMCWValkemaR, et al. Detection of residual disease after neoadjuvant chemoradiotherapy for oesophageal cancer (preSANO): a prospective multicentre, diagnostic cohort study. Lancet Oncol. 2018;19(7):965-974. doi:10.1016/S1470-2045(18)30201-8
21.
van der WilkBJEyckBMDoukasM, et al. Residual disease after neoadjuvant chemoradiotherapy for oesophageal cancer: locations undetected by endoscopic biopsies in the preSANO trial. Br J Surg. 2020;107(13):1791-1800. doi:10.1002/bjs.11760
22.
EyckBMOnstenkBDNoordmanBJ, et al. Accuracy of detecting residual disease after neoadjuvant chemoradiotherapy for esophageal cancer: a systematic review and meta-analysis. Ann Surg. 2020;271(2):245-256. doi:10.1097/SLA.0000000000003397
23.
ZhangXEyckBMYangY, et al. Accuracy of detecting residual disease after neoadjuvant chemoradiotherapy for esophageal squamous cell carcinoma (preSINO trial): a prospective multicenter diagnostic cohort study. BMC Cancer. 2020;20(1):194. doi:10.1186/s12885-020-6669-y
24.
van der WilkBJvan LanschotJJB.Response to the comment on “active surveillance versus immediate surgery in clinically complete responders after neoadjuvant chemoradiotherapy for esophageal cancer. Ann Surg. 2021;274(6):e697-e698. doi:10.1097/SLA.0000000000003861
25.
MarkarSRKarthikesalingamAPennaMLowDE.Assessment of short-term clinical outcomes following salvage esophagectomy for the treatment of esophageal malignancy: systematic review and pooled analysis. Ann Surg Oncol. 2014;21(3):922-931. doi:10.1245/s10434-013-3364-0
26.
MikhailSWeiLSalemMEBekaii-SaabT.Outcomes of definitive chemoradiation in patients with esophageal cancer. Dis Esophagus. 2017;30(2):1-7. doi:10.1111/dote.12506
27.
HippJNagavciBSchmoorCMeerpohlJHoeppnerJSchmuckerC.Post-neoadjuvant surveillance and surgery as needed compared with post-neoadjuvant surgery on principle in multimodal treatment for esophageal cancer: a scoping review. Cancers. 2021;13(3):429. doi:10.3390/cancers13030429
28.
FurlongHBassGBreathnachOO’NeillBLeenEWalshTN. Targeting therapy for esophageal cancer in patients aged 70 and over. J Geriatr Oncol. 2013;4(2):107-13. Epub 2013/09/28. doi: 10.1016/j.jgo.2012.12.006.
29.
TaketaTXiaoLSudoKSuzukiAWadhwaRBlumMA, et al. Propensity-based matching between esophagogastric cancer patients who had surgery and who declined surgery after preoperative chemoradiation. Oncology. 2013;85(2):95-9. Epub 2013/07/19. doi: 10.1159/000351999.
30.
CastoroCScarpaMCagolMAlfieriRRuolACavallinF, et al. Complete clinical response after neoadjuvant chemoradiotherapy for squamous cell cancer of the thoracic oesophagus: is surgery always necessary?J Gastrointest Surg. 2013;17(8):1375-81. Epub 2013/06/26. doi: 10.1007/s11605-013-2269-3.
31.
WilsonKSLimJT. Primary chemo-radiotherapy and selective oesophagectomy for oesophageal cancer: goal of cure with organ preservation. Radiother Oncol.2000;54(2):129-34. Epub 2000/03/04. doi: 10.1016/s0167-8140(99)00174-7.
32.
MurphyCCCorreaAMAjaniJAKomakiRUWelshJWSwisherSG, et al. Surgery is an essential component of multimodality therapy for patients with locally advanced esophageal adenocarcinoma. J Gastrointest Surg. 2013;17(8):1359-69. Epub 2013/05/30. doi: 10.1007/s11605-013-2223-4.
33.
McKenzieSMaileyBArtinyanAMetchikianMShibataSKernstineK, et al. Improved outcomes in the management of esophageal cancer with the addition of surgical resection to chemoradiation therapy. Ann Surg Oncol.2011;18(2):551-8. Epub 2010/09/15. doi: 10.1245/s10434-010-1314-7.
34.
NoordmanBJWijnhovenBPLLagardeSM, et al. Active surveillance in clinically complete responders after neoadjuvant chemoradiotherapy for esophageal or junctional cancer. Dis Esophagus. 2017;30(12):1-8. doi:10.1093/dote/dox100
35.
VersteijneEvan LaarhovenHWvan HooftJE, et al. Definitive chemoradiation for patients with inoperable and/or unresectable esophageal cancer: locoregional recurrence pattern. Dis Esophagus. 2015;28(5):453-459. doi:10.1111/dote.12215
36.
SchroederWGhadimiMPHSchloesserH, et al. Long-term outcome after histopathological complete response with and without nodal metastases following multimodal treatment of esophageal cancer. Ann Surg Oncol. 2022;29:4419-4428. doi:10.1245/s10434-022-11700-3
37.
QuaasASchloesserHFuchsH, et al. Improved tissue processing in esophageal adenocarcinoma after Ivor Lewis esophagectomy allows histological analysis of all surgically removed lymph nodes with significant effects on nodal UICC stages. Ann Surg Oncol. 2021;28(7):3975-3982. doi:10.1245/s10434-020-09450-1
