Molena Daniela, Sewell Marisa, Maron Steve B, Hofstetter Wayne, Worrell Stephanie, Chen Ke-Neng, Enzinger Peter C, Gerdes Hans, Kleinberg Lawrence, Murthy Sudish, Palta Manisha, Pouw Roos E, Reddy Rishindra M, Sanford Dominic E, Schumacher Lana, Sihag Smita, Berry Mark F
Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
J Thorac Cardiovasc Surg. 2025 May 4. doi: 10.1016/j.jtcvs.2025.04.009.
Esophagectomy has been a cornerstone of the treatment of nonmetastatic esophageal cancer, but its use has evolved with advances in endoscopic resection techniques, systemic therapy, and radiation. This document reviews the existing literature and reports multidisciplinary consensus and specific recommendations on how best to treat esophageal and gastroesophageal junction cancer at different stages, including difficult clinical scenarios.
The American Association for Thoracic Surgery Clinical Practice Standards Committee assembled an international, multidisciplinary panel of gastroenterologists, medical oncologists, radiation oncologists, surgical oncologists, and thoracic surgeons with established esophageal and gastroesophageal junction cancer management expertise. A focused literature review was performed with the assistance of a medical librarian. The panel used a modified Delphi method to develop expert consensus statements with a class of recommendations and level of evidence for 3 topics: early-stage adenocarcinoma, locally advanced adenocarcinoma, and squamous cell carcinoma.
Consensus was reached on 23 recommendations, reflecting insights on the basis of the latest literature and current clinical experience that focused on disease stage and histology. The recommendations provide input on the role of surgery, endoscopic therapy, and surveillance for early-stage adenocarcinoma, how to best combine surgery with multimodality therapy for locally advanced adenocarcinoma, and when surgery should be used for patients with squamous cell carcinoma.
Despite the complex nature of esophageal cancer management, consensus on several key recommendations was achieved by this American Association for Thoracic Surgery expert panel. These recommendations, determined on the basis of evidence and developed using the modified Delphi method and expert opinion, provide guidance for thoracic surgeons and other medical professionals who care for esophageal cancer patients.
食管切除术一直是非转移性食管癌治疗的基石，但随着内镜切除技术、全身治疗和放疗的进展，其应用也在不断演变。本文献回顾了现有文献，并报告了关于如何最佳治疗不同阶段食管及胃食管交界癌（包括复杂临床情况）的多学科共识和具体建议。
美国胸外科医师协会临床实践标准委员会组建了一个由胃肠病学家、医学肿瘤学家、放射肿瘤学家、外科肿瘤学家和胸外科医生组成的国际多学科专家小组，这些专家在食管及胃食管交界癌管理方面具有既定的专业知识。在医学图书馆员的协助下进行了重点文献回顾。该专家小组采用改良的德尔菲法，针对早期腺癌、局部晚期腺癌和鳞状细胞癌这3个主题制定了具有推荐类别和证据水平的专家共识声明。
就23项建议达成了共识，这些建议反映了基于最新文献和当前临床经验的见解，重点关注疾病阶段和组织学。这些建议为早期腺癌的手术、内镜治疗和监测的作用提供了参考，为局部晚期腺癌如何最佳地将手术与多模式治疗相结合提供了参考，以及为鳞状细胞癌患者何时应进行手术提供了参考。
尽管食管癌管理具有复杂性，但美国胸外科医师协会专家小组就若干关键建议达成了共识。这些基于证据并采用改良德尔菲法和专家意见制定的建议，为胸外科医生和其他护理食管癌患者的医学专业人员提供了指导。
