New Clinical Practice Guidelines Address Diagnosis, Staging of Esophageal Cancer

Chicago — The Society of Thoracic Surgeons (STS) has released a set of clinical practice guidelines to address current and changing factors that affect the diagnosis and treatment of localized esophageal cancer. The guidelines, the first in a series of clinical practice guidelines on esophageal cancer, appear in the July issue of The Annals of Thoracic Surgery.

Upper gastrointestinal cancers, such as esophageal cancer, are a major health burden, with esophageal cancer the eighth most common cancer worldwide. Optimal treatment often involves coordinated decision-making among multidisciplinary teams.

The STS Workforce on Evidence Based Surgery, in consultation with the STS Workforce on General Thoracic Surgery, assembled a task force with the goal of addressing factors affecting treatment of localized esophageal cancer.

“With the emergence of imaging modalities, such as positron emission tomography (PET), and incorporation of minimally invasive surgical techniques, the STS Workforces recognized the need for a series of esophageal cancer guidelines to help clinicians in practice,” said Thomas K. Varghese Jr., MD, MS, from the University of Washington in Seattle and corresponding author for the guidelines. “Diagnosis and staging are critical steps in the decision-making process for selection of optimal therapy, and hence a natural fit to be the first guidelines of this series.”

Highlights from the new clinical practice guidelines include evidence-based recommendations for the use of computed tomography, PET, endoscopic ultrasound, endoscopic mucosal resection, and staging laparoscopy to assist with staging esophageal cancer. For diagnosis, barium studies may help, but the primary recommendation is flexible endoscopy with biopsy.

“Quality, research, and patient safety initiatives are vital components of STS efforts to help provide the highest level of care for patients,” said Dr. Varghese. “These clinical practice guidelines were developed as a resource for the health care team to help with these missions, advocating delivery of evidence-based best practices for all of our patients at all times.”

Data show that for the past 4 decades the incidence of esophageal cancer in the United States has increased at the fastest rate of any solid tumor. Esophageal cancer is also one of the most lethal cancers with an overall 5-year survival rate of less than 15%, according to background information in the publication.


Esophageal Cancer Guideline Series Development Process
In an editorial in the same issue, John D. Mitchell, MD, from the University of Colorado in Aurora, and Mark J. Krasna, MD, from Jersey Shore University Medical Center in Neptune, NJ, outlined the development process for the new guidelines and their importance to clinical practice.

“With the increasing incidence of esophageal cancer around the world, this disease has become even more important in the typical practice of the thoracic surgeon,” the authors said. “This is a first attempt on the part of the thoracic surgical community to use evidence-based practices for the evaluation of esophageal cancer patients. It also sets a precedent for the surgeon to play a pivotal role in the assessment and management of patients with this dreaded disease.”

The authors added: “Future clinical practice guidelines will review the evaluation and treatment of the continuum of Barrett’s esophagus to early stage esophageal cancer, the role of multimodality therapy in esophageal malignancy, and the choice of esophageal resection techniques.”


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For a copy of these STS Clinical Practice Guidelines, contact Cassie Brasseur at 312-202-5865 or
cbrasseur [at] sts [dot] org.

Founded in 1964, The Society of Thoracic Surgeons is a not-for-profit organization representing more than 6,600 cardiothoracic surgeons, researchers, and allied health care professionals worldwide who are dedicated to ensuring the best possible outcomes for surgeries of the heart, lung, and esophagus, as well as other surgical procedures within the chest. The Society’s mission is to enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research, and advocacy.

The Annals of Thoracic Surgery is the official journal of STS and the Southern Thoracic Surgical Association.

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