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Consensus statement of the Hellenic and Cypriot Oesophageal Cancer Study Group on the diagnosis, staging and management of oesophageal cancer

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Abstract

In spite of recent advances in the diagnosis and management of oesophageal cancer, the overall survival of the disease worldwide remains disappointingly low. In Greece and Cyprus, this may be partly due to a failure of health care providers to implement standardised treatment protocols in clinical practice. Development of clinical practice guidelines was undertaken as a joint project between the Hellenic Society of Medical Oncology (HeSMO) and Gastro-Intestinal Cancer Study Group (GIC-SG) in an effort to provide guidance for Greek and Cypriot clinicians in all aspects of the management of oesophageal cancer. A study group was formed comprising clinicians from different disciplines with a special interest in the management of oesophageal cancer. Following extensive review of the literature, the members of the group met in person and consensus statements were developed, which were later subjected to the Delphi survey process by invited national and international experts. Statements that achieved a rate of voting consensus > 80% were adopted. Those that reached a voting consensus of < 80% were revised or rejected. In total, 46 sentences were developed and subjected to the voting process. Of those, 45 sentences achieved a rate of consensus > 80% during the first voting round. One sentence that did not reach a satisfactory rate of consensus was revised by the members of the study group and subsequently incorporated to the final statement. Forty-six recommendations covering all aspects of the management of oesophageal cancer and concise treatment algorithms are proposed by the Hellenic and Cypriot Oesophageal Cancer Study Group. In particular, centralisation of services, care by multidisciplinary teams and adherence to clinical guidelines are strongly recommended.

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Funding

The Hellenic Society of Medical Oncology (HESMO) paid for travelling and meeting expenses incurred by the members of the Oesophageal Cancer study Group during the preparation of the manuscript. The Gastro-Intestinal Cancer Study Group (GIC-SG) has covered publication fees.

Author information

Authors and Affiliations

  1. Department of General Surgery, Athens Medical Centre, Athens, Greece

    Andreas Fountoulakis

  2. Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Greece

    John Souglakos

  3. Department of Radiotherapy, Athens Medical Centre, Athens, Greece

    Louiza Vini

  4. Department of General Surgery, Thriasseion General Hospital, Athens, Greece

    Gerasimos N. Douridas

  5. Department of Medical Oncology, Attikon University Hospital, Athens, Greece

    Anna Koumarianou

  6. Oncology Centre of Bank of Cyprus, Nicosia, Cyprus

    Panteleimon Kountourakis

  7. 1st Department of General Surgery, Naval Hospital, Athens, Greece

    Christos Agalianos

  8. 1st University Department of General Surgery, Laikon Hospital, Athens, Greece

    Andreas Alexandrou & Theodoros Liakakos

  9. Department of General Surgery, Faculty of Medicine, University of Cyprus, Nicosia, Cyprus

    Christos Dervenis

  10. Department of Radiology, Areteio University Hospital, Athens, Greece

    Sofia Gourtsoyianni

  11. Department of General Surgery, Worcestershire Acute Hospitals NHS Trust, Worcester, UK

    Nikolaos Gouvas

  12. Department of Radiotherapy, Alexandra Hospital, Athens, Greece

    Maria-Angeliki Kalogeridi

  13. Department of Human Pathology, Erlagen, Germany

    Georgia Levidou

  14. Department of Medical Oncology, Agioi Anargyroi Hospital, Athens, Greece

    Joseph Sgouros

  15. Department of Gastroenterology, Naval Hospital, Athens, Greece

    Spiros N. Sgouros

  16. Department of Radiology, Konstandopouleion Hospital, Athens, Greece

    Charikleia Triantopoulou

  17. Department of General Surgery, Creta Interclinic Hospital, Heraklion, Greece

    Evangelos Xynos

Authors
  1. Andreas Fountoulakis
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  2. John Souglakos
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  3. Louiza Vini
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  4. Gerasimos N. Douridas
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  5. Anna Koumarianou
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  6. Panteleimon Kountourakis
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  7. Christos Agalianos
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  8. Andreas Alexandrou
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  10. Sofia Gourtsoyianni
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  13. Georgia Levidou
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  14. Theodoros Liakakos
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  15. Joseph Sgouros
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  17. Charikleia Triantopoulou
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  18. Evangelos Xynos
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Corresponding author

Correspondence to Andreas Fountoulakis.

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Conflict of interest

Dr. KALOGERIDI reports non-financial support from Sanofi, outside the submitted work; Dr. XYNOS reports non-financial support from Johnson & Johnson, outside the submitted work; Dr. SOUGLAKOS reports grants from Amgen, grants and personal fees from Roche, grants and personal fees from Sanofi, personal fees from Servier, personal fees from MSD, personal fees from Merck Serono, personal fees from CellGene, outside the submitted work.

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No human participants or animals were involved during the execution of this research project.

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Legal disclaimer

The study group considers adherence to these guidelines to be voluntary. The ultimate determination regarding their application is to be made by the physician in light of each patient’s individual circumstances. In view of the consulting and non-binding nature, these guidelines cannot form the basis for legal action or litigation for compliance or absence of compliance in the clinical practice setting, but can only be considered as general guidelines based on best available evidence for assistance in decision making. Any person seeking to apply or consult the evidence-based series is expected to use independent medical judgment in the context of individual clinical circumstances or seek out the supervision of a qualified clinician. HCGC-SG makes no representation or guarantees of any kind whatsoever regarding their content or use or application and disclaims any responsibility for their application or use in any way. In addition, these guidelines describe evaluations and administration of therapies in clinical practice; they cannot be assumed to apply to interventions performed in the context of clinical trials, given that such clinical studies are designed to test innovative management strategies in a disease for which better treatment is sorely needed. However, by reviewing and synthesising the latest literature, this practice guideline serves to identify questions for further research and the settings in which investigational therapy should be considered.

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All the authors are members of the Hellenic and Cypriot Oesophageal Cancer Study Group (HCOC-SG) on behalf of the Hellenic Society of Medical Oncology (HESMO) and the Gastro-Intestinal Cancer Study Group (GIC-SG).

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Fountoulakis, A., Souglakos, J., Vini, L. et al. Consensus statement of the Hellenic and Cypriot Oesophageal Cancer Study Group on the diagnosis, staging and management of oesophageal cancer. Updates Surg 71, 599–624 (2019). https://doi.org/10.1007/s13304-019-00696-3

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