• Annals of surgery · Oct 2023

    Implementation of Screening Guidelines in Early Esophageal Cancer: A Study of the Society of Thoracic Surgeons General Thoracic Surgery Database.

    • Joseph A Reza, Vignesh Raman, Andrew Vekstein, Maria Grau-Sepulveda, William P Burfeind, Kristine Chin, Roman Petrov, and Cherie P Erkmen.
    • Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA.
    • Ann. Surg. 2023 Oct 1; 278 (4): e754e759e754-e759.

    ObjectiveTo evaluate the adoption and clinical impact of endoscopic resection (ER) in early esophageal cancer.BackgroundStaging for early esophageal cancer is largely inaccurate. Assessment of the impact of ER on staging accuracy is unknown, as is the implementation of ER.MethodsWe retrospectively reviewed 2608 patients captured in the Society of Thoracic Surgeons General Thoracic Surgery Database between 2015 and 2020. Patients with clinical T1 and T2 esophageal cancer without nodal involvement (N0) who were treated with upfront esophagectomy were included. Staging accuracy was assessed by clinical-pathologic concordance among patients staged with and without ER. We also sought to measure adherence to National Comprehensive Cancer Network staging guidelines for esophageal cancer staging, specifically the implementation of ER.ResultsFor early esophageal cancer, computed tomography/positron emission tomography/endoscopic ultrasound (CT/PET/EUS) accurately predicts the pathologic tumor (T) stage 58.5% of the time. The addition of ER to staging was related to a decrease in upstaging from 17.6% to 10.8% ( P =0.01). Adherence to staging guidelines with CT/PET/EUS improved from 58.2% between 2012 and 2014 to 77.9% between 2015 and 2020. However, when ER was added as a staging criterion, adherence decreased to 23.3%. Increased volume of esophagectomies within an institution was associated with increased staging adherence with ER ( P =0.008).ConclusionsThe use of CT/PET/EUS for the staging of early esophageal cancer is accurate in only 56.3% of patients. ER may increase staging accuracy as it is related to a decrease in upstaging. ER is poorly utilized in staging of early esophageal cancer. Barriers to the implementation of ER as a staging modality should be identified and corrected.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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