New Clinical Guidelines Issued for Esophageal Cancer

Κατευθυντήριες οδηγίες για καρκίνο οισοφάγου

The Society of Thoracic Surgeons (STS) has released a set of clinical-practice guidelines to assist in the diagnosis and treatment of localized esophageal cancer.

The Society of Thoracic Surgeons Guidelines on the Diagnosis and Staging of Patients With Esophageal Cancer

One of the key recommendations is that endoscopy with biopsy is the diagnostic test of choice for esophageal cancer. Another key recommendation is that staging should be done with computed tomography (CT) and positron emission tomography (PET)/CT. The authors also recommend that endoscopic ultrasonography be used for patients who are surgical candidates to determine the locoregional extent of disease.

The Annals of Thoracic Surgery, Vol 96, Issue 1 , Pages 346-356, July 2013

Thomas K. Varghese Jr., MD, MS, Wayne L. Hofstetter, MD, Nabil P. Rizk, MD, Donald E. Low, MD, Gail E. Darling, MD, Thomas J. Watson, MD, John D. Mitchell, MD, Mark J. Krasna, MD

Executive Summary 

Diagnosis of Esophageal Cancer 

Flexible endoscopy with biopsy is the primary method for the diagnosis of esophageal carcinoma (Class I recommendation: level of evidence B)

Staging of Esophageal Cancer

1.For early stage esophageal cancer, computed tomography of the chest and abdomen is an optional test for staging. (Class I recommendation: level of evidence B)

2.For locoregionalized esophageal cancer, computed tomography of the chest and abdomen is a recommended test for staging. (Class I recommendation: level of evidence B)

3.For early stage esophageal cancer, positron emission tomography is an optional test for staging. (Class IIB recommendation: level of evidence B)

4.For locoregionalized esophageal cancer, positron emission tomography is a recommended test for staging. (Class I recommendation: level of evidence B)

5.In the absence of metastatic disease, endoscopic ultrasonography is recommended to improve the accuracy of clinical staging. (Class IIA recommendation: level of evidence B)

6.Endoscopic mucosal resection should be considered as a diagnostic/staging tool for small, discrete nodules or areas of dysplasia when the disease appears limited to the mucosa or submucosa as assessed by endoscopic ultrasonography. (Class IIA recommendation: level of evidence B)

7.For locally advanced (T3/T4) adenocarcinoma of the esophagogastric junction infiltrating the anatomic cardia, or Siewart type III esophagogastric tumors, laparoscopy is recommended to improve the accuracy of staging. (Class IIB recommendation: level of evidence C)

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