European Surgery

, Volume 38, Issue 2, pp 79–88

Esophageal cancer: International guidelines in interdisciplinary diagnosis and treatment

Main Topic


BACKGROUND: Diagnostic and therapeutic management of esophageal cancer is a multidisciplinary challenge. This article aims to highlight guidelines of international societies and networks for esophageal malignancies. METHODS: Guidelines of 7 international cancer organisations were reviewed and merged. RESULTS: Surgery is the single modality offering complete tumour clearance in early stages but bears remarkable morbidity. Also after radiotherapy, long-term survival may be reached. In advanced stages multimodal strategies have been adopted since prognosis is poor. CONCLUSIONS: In this article the guidelines of seven international societies and networks are collected offering a summary of recommendations in esophageal cancer care.


Esophageal cancer Surgery Chemotherapy Radiotherapy Staging Interdisciplinary management Guideline Review 

ösophagus-Karzinom: Internationale Leitlinien zur interdisziplinären Diagnose und Therapie


GRUNDLAGEN: Diagnostik, Staging und Therapie des ösophaguskarzinoms sind eine interdisziplinäre Herausforderung. Dieser Übersichtsartikel soll die Leitlinien von internationalen Gesellschaften über das Management von ösophagealen Malignomen zusammenfassen. METHODIK: Leitlinien von sieben onkologischen und chirurgischen Organisationen wurden fusioniert. ERGEBNISSE: Die chirurgische Therapie bietet in frühen Stadien als einzige Modalität die komplette Tumorentfernung, birgt aber beträchtliche Morbidität. Auch mit der Strahlentherapie kann Langzeitüberleben erreicht werden. Beim lokal fortgeschrittenen Karzinom werden aufgrund der schlechten Prognose multimodale Konzepte aufgegriffen. SCHLUSSFOLGERUNGEN: In dieser Übersicht werden die Leitlinien von sieben internationalen Gesellschaften zu einem Kompendium der Behandlung des ösophaguskarzinoms zusammengefasst.


ösophaguskarzinom Chirurgie Chemotherapie Strahlentherapie Staging Interdisziplinäres Management Leitlinien Übersichtsarbeit 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Ginsberg R, Roth J, Fergusson M (1997) Esophageal Cancer Surgical Practice Guidelines. Oncology 11: 1059–1065PubMedGoogle Scholar
  2. Bartels H, Stein HJ, Siewert JR (1998) Preoperative riskanalysis and postoperative mortality of oesophagectomy for resectable oesophageal cancer. Br J Surg 85: 840–844PubMedCrossRefGoogle Scholar
  3. UICC (2002) TNM-Klassifikation maligner Tumoren, 6. Auflage. Wittekind C, Wagner G (Hrsg) Springer, Berlin Heidelberg, New York TokyoGoogle Scholar
  4. UICC (2001) TNM supplement, 2nd ed. A commentary on uniform use. Wittekind C, Henson DE, Hutter RVP, Sobin LH (eds). John Wiley and Sons, New YorkGoogle Scholar
  5. Brücher BLDM, Weber W, Bauer M, Fink U, Avril N, Stein HJ, Werner M, Zimmermann F, Siewert JR, Schwaiger M (2001) Neoadjuvant therapy of esophageal squamous cell carcinoma: response evaluation by positron emission tomography. Ann Surg 233: 300–309PubMedCrossRefGoogle Scholar
  6. Weber WA, Ott K, Becker K, Dittler HJ, Helmberger H, Avril NE, Meisetschlager G, Busch R, Siewert JR, Schwaiger M, Fink U (2001) Prediction of response to preoperative chemotherapy in adenocarcinomas of the esophagogastric junction by metabolic imaging. J Clin Oncol 19: 3058–3065PubMedGoogle Scholar
  7. Begg CB, Cramer LD, Hoskins WJ, Brennan MF (1998) Impact of hospital volume on operative mortality for major cancer surgery. JAMA 280: 1747–1751PubMedCrossRefGoogle Scholar
  8. Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL (2003) Surgeon volume and operative mortality in the United States. N Engl J Med 349: 2117–2127PubMedCrossRefGoogle Scholar
  9. Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346: 1128–1137PubMedCrossRefGoogle Scholar
  10. Kelley DJ, Wolf R, Shaha AR, Spiro RH, Bains MS, Kraus DH, Shah JP (1995) Impact of clinicopathologic parameters on patient survival in carcinoma of the cervical esophagus. Am J Surg 170: 427–431PubMedCrossRefGoogle Scholar
  11. Wei WI, Lam LK, Yuen PW, Wong J (1998) Current status of pharyngolaryngo-esophagectomy and pharyngogastric anastomosis. Head Neck 20: 240–244PubMedCrossRefGoogle Scholar
  12. Urschel JD, Urschel DM, Miller JD, Bennet WF, Young JE (2001) A meta-analysis of randomized controlled trials of route of reconstruction after esophagectomy for cancer. Am J Surg 182: 470–475PubMedCrossRefGoogle Scholar
  13. Hartel M, Wente MN, Büchler MW, Friess H (2004) Surgical Treatment of Oesophageal Cancer. Dig Dis 22: 213–220PubMedCrossRefGoogle Scholar
  14. Law S, Cheung MC, Fok M, Chu KM, Wong J (1997) Pyloroplasty and pyloromyotomy in gastric replacement of the esophagus after esophagectomy: a randomized controlled trial. J Am Coll Surg 184: 630–636PubMedGoogle Scholar
  15. Manjari R, Padhy AK, Chattopadhyay TK (1996) Emptying of the intrathoracic stomach using three different pylorus drainage procedures – results of a comparative study. Surg Today 26: 581–585PubMedCrossRefGoogle Scholar
  16. Chasseray VM, Kiroff GK, Buard JL et al (1989) Cervical or thoracic anastomosis for esophagectomy for carcinoma. Surg Gynecol Obstet 169: 55–62PubMedGoogle Scholar
  17. Walther B, Johansson J, Johnsson F, von Holstein CS, Zilling T (2003) Cervical or thoracic anastomosis after esophageal resection and gastric tube reconstruction. Ann Surg 238: 803–814PubMedGoogle Scholar
  18. Urschel JD, Blewett CJ, Bennett WF, Miller JD, Young JE (2001) Handsewn or stapled esophagogastric anastomoses after esophagectomy for cancer: meta-analysis of randomized controlled trials. Dis Esophagus 14: 212–217PubMedCrossRefGoogle Scholar
  19. Hsu HH, Chen JS, Huang PM, Lee JM, Lee YC (2004) Comparison of manual and mechanical cervical esophagogastric anastomosis after esophageal resection for squamous cell carcinoma: a prospective randomized trial. Eur J Cardiothor Surg 25: 1097–1101CrossRefGoogle Scholar
  20. Stein HJ, Feith M, Müller J, Werner M, Siewert JR (2000) Limited resection for early adenocarcnoma in Barrett's esophagus. Ann Surg 232: 733–742PubMedCrossRefGoogle Scholar
  21. Van Sandick JW, van Lanschott JJ, ten Kate FJ, Offerhaus GJ, Fockens P, Tytgat GN, Obertop H (2000) Pathology of early invasive adenocarcinoma of the esophagus or esophagogastric junction: implications for therapeutic decision making. Cancer 88: 2429–2437PubMedCrossRefGoogle Scholar
  22. Fumagalli U and Panel of Experts (1996) Resective surgery for cancer of the thoracic esophagus. Results of a consensus conference held at the 6th World Congress of the International society for diseases of the esophagus. Dis Esoph 9(Suppl 1): 30–38Google Scholar
  23. Luketich JD, Alvelo-Rivera M, Buenaventura PO, Christie NA, McCaughan JS, Litle VR, Schauer PR, Close JM, Fernando HC (2003) Minimally invasive esophagectomy. Outcomes in 222 patients. Ann Surg 238: 486–495PubMedGoogle Scholar
  24. Zacherl J, Jakesz R (2000) Stand der chirurgischen Studien in der Onkologie, Teil 1. Chirurg 71: 646–657PubMedCrossRefGoogle Scholar
  25. Malthaner RA, Wong RKS, Rumble RB, Zuraw L (2004) Neoadjuvant or adjuvant therapy for resectable esophageal cancer: A systematic review and meta-analysis. BMC Medicine 2: 35–51PubMedCrossRefGoogle Scholar
  26. Malthaner RA, Wong RKS, Rumble RB, Zuraw L (2004) Neoadjuvant or adjuvant therapy for resectable esophageal cancer: A clinical practice guideline. BMC Cancer 4: 67–71PubMedCrossRefGoogle Scholar
  27. Medical Research Council Oesophageal Cancer Working Party (2002) Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet 359: 1727–1733CrossRefGoogle Scholar
  28. Fiorica F, Di Bona D, Schepis F, Licata A, Shahied L, Venturi A, Falchi AM, Craxi A, Camma C (2004) Preoperative chemoradiotherpy for esophageal cancer: a systematic review and meta-analysis. Gut 53: 925–930PubMedCrossRefGoogle Scholar
  29. Bosset JF, Gignoux M, Triboulet JP, Tiret E, Mantion G, Elias D, Lozach P, Ollier JC, Pavy JJ, Mercier M, Sahmoud T (1997) Chemoradiotherapy followed by surgery compared to surgery alone in squamous cell cancer of the esophagus. N Engl J Med 337: 161–167PubMedCrossRefGoogle Scholar
  30. Urba S, Orringer MB, Turrisi A, Iannettoni M, Forastiere A, Strawderman M (2001) Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 19: 305–313PubMedGoogle Scholar
  31. Ancona E, Ruol A, Santi S, Merigliano S, Sileni VC, Koussis H, Zaninotto G, Bonavina L, Peracchia A (2001) Only pathologically complete response to neoadjuvant chemotherapy improves significantly the long term survival of patients with resectable esophageal squamous cell carcinoma: final report of a randomized controlled trial of preoperative chemotherapy versus surgery alone. Cancer 91: 2165–2174PubMedCrossRefGoogle Scholar
  32. Wong RKS, Malthaner RA, Zuraw L, Rumble RB (2003) Combined modality radiotherapy and chemotherapy in nonsurgical management of localized carcinoma of the esophagus: A practice guideline. Int J Radiation Oncology Biol Phys 55(4): 930–942CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Division of General Surgery, Department of SurgeryMedical University of ViennaViennaAustria

Personalised recommendations