Skip to main content
SpringerLink
Log in

Quality Indicators of Surgery for Adenocarcinoma of the Esophagus and Gastroesophageal Junction

  • Chapter
  • First Online:
Adenocarcinoma of the Esophagogastric Junction

Part of the book series: Recent Results in Cancer Research ((RECENTCANCER,volume 182))

Abstract

Surgical treatment of adenocarcinoma of the esophagus and gastroesophageal junction is complex and challenging. Huge variation exist in the immediate and long term outcomes of such interventions and it is generally accepted that this is a direct consequence of the experience of the surgical team. However beside surgical quality many other indicators of quality management may influence outcome. Definition of the gastroesophageal junction remains controversial and the performance of staging procedures i.e. CT scan, endoscopy and fine needle aspiration, PET scan still suboptimal. As a result there is disagreement on the selection of patients for surgery, type of surgical approach in particular in relation to the extent of lymph node dissection as well as the extent of esophageal and/or gastric resection. In the design of randomized controlled trials comparing primary surgery versus multimodality treatment surgical quality criteria are notoriously lacking. It therefore remains a matter of debate which patients eventually will benefit from primary surgery versus those who will benefit from induction therapy. A lack of surgical quality indicators is also very prominent when assessing the value of new surgical technologies such as minimally invasive surgery or robotic surgery. Improvements in this wide spectrum of aspects is mandatory and will certainly be of great value to further improve both short and long term outcome after surgery for these complex cancers.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Altorki N (2005) En-bloc esophagectomy. The three-field dissection. Surg Clin N Am 85:611–619

    Article  PubMed  Google Scholar 

  • Ancona E, Ruol A, Santi S et al (2001) Only pathologic complete response to neoadjuvant ­chemo-therapy improves significantly the long term survival of patients with resectable esophageal squamous cell carcinoma. Cancer 91:2165–2174

    Article  PubMed  CAS  Google Scholar 

  • Bandstrup B (2006) Fluid therapy for the surgical patient. Best Pract Res Clin Anesthesiol 20:265–283

    Article  Google Scholar 

  • Bedenne L, Michel P, Bouché O, Milan C, Mariette C, Conroy T, Pezet D, Roullet B, Seitz J, Herr J, Paillot B, Arveux P, Bonnetain F, Binquet C (2007) Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol 25:1160–1168

    Article  PubMed  CAS  Google Scholar 

  • Birkmeyer JD, Siewers AE, Finlayson EVA, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346:1128–1137

    Article  PubMed  Google Scholar 

  • Birkmeyer JD, Sun Y, Wong SL, Stukel TA (2007) Hospital volume and late survival after cancer surgery. Ann Surg 245:777–783

    Article  PubMed  Google Scholar 

  • Blumenthal D (1996) Measuring quality of care. New Engl J Med 335:966–970

    Article  Google Scholar 

  • Bandstrup B, Tonnesen H, Beier-Holgersen R, Hjortso E, Ording H, Lindorff-Larsen K et al (2003) Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg 238:641–648

    Article  PubMed  Google Scholar 

  • Cerfolio RJ, Bryant AS, Bass CS, Alexander JR, Bartolucci AA (2004) Fast tracking after Ivor Lewis esophagogastrectomy. Chest 126:1187–1194

    Article  PubMed  Google Scholar 

  • Chang AC, Ji H, Birkmeyer NJ, Orringer MB, Birkmeyer JD (2008) Outcomes after transhiatal and transthoracic esophagectomy for cancer. Ann Thorac Surg 85:424–429

    Article  PubMed  Google Scholar 

  • Chemaly M, Scalone O, Durivage G, Napoleon B, Pujol B, Lefort C, Hervieux V, Scoazec JY, Souquet JC, Ponchon T (2008) Miniprobe EUS in the pretherapeutic assessment of early esophageal neoplasia. Endoscopy 40:2–6

    Article  PubMed  CAS  Google Scholar 

  • Cushieri A, Shimi S, Banting S (1992) Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb 37:7–11

    Google Scholar 

  • De Manzoni G, Pedrazzani C, di Leo A et al (1999) Experience of endoscopic ultrasound with a 20-Mhz ultrasound thin probe. Eur J Surg Oncol 25:595–598

    Article  PubMed  Google Scholar 

  • Decker G, Coosemans W, De Leyn P, Decaluwé H, Nafteux P, Van Raemdonck D, Lerut T (2009) Minimally invasive esophagectomy for cancer. Eur J Cardiothorac Surg 35:13–21

    Article  PubMed  Google Scholar 

  • Driessen A, Van Raemdonck D, De Leyn P et al (2003) Are carcinomas of the cardia oesophageal or gastric adenocarcinomas? Eur J Cancer 39:2487–2494

    Article  PubMed  CAS  Google Scholar 

  • Driessen A, Nafteux P, Lerut T et al (2004) Identical cytokeratin expression pattern CK7+/CK20- in esophageal and cardiac cancer: etiopathological and clinical implications. Mod Pathol 17:49–55

    Article  PubMed  CAS  Google Scholar 

  • Edge S.B, Byrd D.R., Compton C, Fritz A.G., Greene F.L., Trotti A (2009) AJCC Cancer Staging Manual 7th Edition, Springer, New York

    Google Scholar 

  • Egger M, Ebrahim S, Smith GD (2002) Where now for meta-analysis? Int J Epidemiol 31:1–5

    Google Scholar 

  • Enzinger PC, Mayer RJ (2003) Esophageal cancer. N Engl J Med 349:2241–2252

    Article  PubMed  CAS  Google Scholar 

  • Fiorica F, Di Bona D, Schepsis F et al (2004) Preoperative chemoradiotherapy for esophageal cancer: a systematic review and meta-analysis. Gut 53:925–930

    Article  PubMed  CAS  Google Scholar 

  • Fumagalli U (1996) Resective surgery for cancer of thoracic esophagus. Results of a consensus conference of the International Society for Diseases of the Esophagus. Dis Esophagus 9:30–38

    Google Scholar 

  • Gebski V, Burmeister B, Smithers B, Foo K, Zal­cberg J, Simes J, Australasian Gastro-Intestinal Trials Group (2007) Survival benefits for neo-adjuvant chemoradiotherapy or chemo-therapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol 8:226–234

    Article  PubMed  CAS  Google Scholar 

  • Geh JI, Bond SJ, Bentzen SM et al (2006) Systematic overview of preoperative (neoadjuvant) chemoradiotherapy trials in oesophageal cancer: evidence of a radiation and chemotherapy dose response. Radiother Oncol 78:236–244

    Article  PubMed  CAS  Google Scholar 

  • Greene FL, Page DL, Fleming ID, Fritz AG, Balck CM, Haller DG, Morrow M (2002) AJCC cancer staging handbook. TNM classification of malignant tumors, 6th edn. Springer, New York

    Google Scholar 

  • Greer S, Goodney P, Sutton J, Birkmeyer J (2005) Neo-adjuvant chemoradiotherapy for esophageal carcinoma: a meta-analysis. Surgery 137: 172–177

    Article  PubMed  Google Scholar 

  • Guideline for the esophageal and gastric cancer: scientific support of the college of Oncology. www.kce.fgov.be. 21 Mar 2008

  • Holte K, Kehlet H (2006) Fluid therapy and surgical outcomes in elective surgery: a need for reassessment in fast-track surgery. J Am Coll Surg 202:971–989

    Article  PubMed  Google Scholar 

  • Hulscher JBF, Tijssen JGP, Obertop H, van Lanschot JJB (2001) Transthoracic versus transhiatal resection for carcinoma of the esophagus: a meta-analysis. Ann Thor Surg 72:306–313

    Article  CAS  Google Scholar 

  • Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12

    Article  PubMed  CAS  Google Scholar 

  • Joshi GP (2005) Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery. Anesth Analg 101:601–605

    Article  PubMed  Google Scholar 

  • Kelly S, Harris KM, Berry E et al (2001) A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma. Gut 49:534–539

    Article  PubMed  CAS  Google Scholar 

  • Kelsen D, Ginsberg R, Pajak T, Sheahan D, Gund­erson L, Mortimer J, Estes N, Haller D, Ajani J, Kocha W, Minsky B, Roth J (1998) Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med 339:1979–1984

    Article  PubMed  CAS  Google Scholar 

  • Kutup A, Link BC, Schurr PG, Strate T, Kaifi JT, Bu­b­enheim M, Seewald S, Yekebas EF, Soe­hendra N, Izbicki JR (2007) Quality control of endoscopic ultrasound in preoperative staging of esophageal cancer. Endoscopy 39:715–719

    Article  PubMed  CAS  Google Scholar 

  • Lagarde SM, ten Kate FJ et al (2006) Prognostic factors in adenocarcinoma of the esophagus or gastroesophageal junction. J Clin Oncol 24:4347–4355

    Article  PubMed  Google Scholar 

  • Law S (2006) Minimally invasive techniques for oesophageal cancer surgery. Best Pract Res Clin Gastroent 20:925–940

    Article  Google Scholar 

  • Lerut T, Coosemans W, De Leyn P, Van Raemdonck D, Nafteux P, Moons J (2001) Optimizing treatment of carcinoma of the esophagus and gastroesophageal junction. Surg Clin North Am 10:863–884

    CAS  Google Scholar 

  • Lerut T, Coosemans W, Decker G, De Leyn P, Ectors N, Fieuws S, Moons J, Nafteux P, Van Raemdonck D; for the Leuven Collaborative Workgroup for Esophageal Carcinoma (2003) Extracapsular lymph node involvement is a negative prognostic factor in T3 adenocarcinoma of the distal esophagus and gastroesophageal junction. J Thor Cardiovasc Surg 126:1121–1128

    Google Scholar 

  • Lerut T, Nafteux P, Moons J, Coosemans W, Decker G, De Leyn P, Van Raemdonck D, Ectors N (2004) Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 R0 resections: impact on staging, disease-free survival and outcome: a plea for adaptation of TNM classification in upper-half esophageal carcinoma. Ann Surg 240:962–974

    Article  PubMed  CAS  Google Scholar 

  • Lerut T, Moons J, Coosemans W, Decaluwé H, Decker G, De Leyn P, Nafteux P, VanRaemdonck D (2008) Multidisciplinary treatment of advanced cancer of the esophagus and gastroesophageal junction: a European center’s approach. Surg Oncol Clin N Am 17:485–502

    Article  PubMed  Google Scholar 

  • Lightdale CJ, Kulkarni KG (2005) Role of endoscopic ultrasonography in the staging and follow-up of esophageal cancer. J Clin Oncol 23:4483–4489

    Article  PubMed  Google Scholar 

  • Low DE (2007) Evolution in perioperative management of patients undergoing oesophagectomy. Br J of Surg 94:655–656

    Article  CAS  Google Scholar 

  • 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 238:486–495

    PubMed  Google Scholar 

  • Malthaner R, Fenlon D (2003) Preoperative chemotherapy for resectable esophageal cancer. Cochrane Database Syst Rev (4):CD001556

    Google Scholar 

  • Malthaner R, Wong R, Rumble R, Zuraw L (2004) Gastrointestinal Disease Group of Cancer Care Ontario’s Program in evidence-based care. Neo-adjuvant or adjuvant therapy for resectable esophageal cancer: a clinical practice guideline. BMC Cancer 4:67

    Article  PubMed  Google Scholar 

  • May A, Günter E, Roth F, Gossner L, Stolte M, Vieth M, Ell C (2004) Accuracy of staging in early oesophageal cancer using high resolution endoscopy and high resolution endosonography: a comparative, prospective and blinded trial. Gut 53:634–640

    Article  PubMed  CAS  Google Scholar 

  • Medical Research Council Oesophageal Cancer Working Group (2002) Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet 359:1727–1734

    Article  Google Scholar 

  • Meyers BF, Downey RJ, Decker PA, Keenan RJ, Siegel BA, Cerfolio RJ, Landreneau RJ, Reed CE, Balfe DM, Dehdashti F, Ballman KV, Rusch VW, Putnam JB (2007) The utility of positron emission tomography in staging of potentially operable carcinoma of the thoracic esophagus: results of the American College of Surgeons Oncology Group Z0060 trial. J Thorac Cardiovasc Surg 133:738–745

    Article  PubMed  Google Scholar 

  • NCCN. NCCN (2002) clinical practice guidelines in oncology: esophageal cancer. Version 2009. www.nccn.org

  • Nishimaki T (2006) An appropriate esophagectomy for esophageal cancer: a lack of evidence and a growing disparity between Western and Eastern standards. Ann Thorac Cardiovasc Surg 12:231–233

    PubMed  Google Scholar 

  • Omloo JM, Lagarde SM, Hulscher JB, Reitsma JB, Fockens P, van Dekken H, Ten Kate FJ, Obertop H, Tilanus HW, van Lanschot JJ (2007) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg 246:992–1000

    Article  PubMed  Google Scholar 

  • Pera M, Manterola C et al (2005) Epidemiology of esophageal adenocarcinoma. J Surg Oncol 92: 151–9

    Article  PubMed  Google Scholar 

  • Peters FP, Brakenhoff KPM, Curvers WL, Rosmolen WD, Fockens P, ten Kate FJW, Krishnadath KK, Bergman JJ (2008) Histologic evaluation of resection specimens obtained at 293 endoscopic resections in Barrett’s esophagus. Gastroint Endosc 67:604–609

    Article  Google Scholar 

  • Peyre C, Hagen J, DeMeester SR, Altorki NK, Ancona E, Griffin SM, Hölscher A, Lerut T, Law S, Rice T, Ruol A, van Lanschot JJB, Wong J, De Meester TR (2008) The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg 248:549–555

    Google Scholar 

  • Rindani R, Martin CJ, Cox MR (1999) Transhiatal versus Ivor-Lewis oesophagectomy: is there a difference? Aust NZ J Surg 69:187–194

    Article  CAS  Google Scholar 

  • Siewert JR, Stein HJ (1998) Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg 85:1457–1459

    Article  PubMed  CAS  Google Scholar 

  • Smithers BM, Gotley DC, Martin I, Thomas JM (2007) Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg 245:232–240

    Article  PubMed  Google Scholar 

  • Sobin LH, Wittekind C (eds) (2002) International Union against cancer (IUICC) TNM classification of malignant tumours, 6th edn. Wiley-Liss, New-York

    Google Scholar 

  • Spechler SJ, Dixon MF, Genta R, Hainaut P, Lambert R, Siewert R (2000) Adenocarcinoma of the esophago-gastric junction. In: Hamilton SR, Aaltonen LA (eds) World Health Organization classification of tumours, vol 2. Pathology and genetics of tumours of the digestive system. IARC, Lyon, France, pp 31–36

    Google Scholar 

  • Stahl M, Stuschke M, Lehmann N, Meyer H, Walz M, Seeber S, Klump B, Budach W, Teichmann R, Schmitt M, Schmitt G, Franke C, Wilke H (2005) Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. JCO 23:2310

    Article  Google Scholar 

  • Urschel J, Vasan H (2003) A meta-analysis of randomized controlled trials that compared neo-adjuvant chemoradiation and surgery to surgery alone for resectable esophageal cancer. Am J Surg 185:538–543

    Article  PubMed  Google Scholar 

  • van Lanschot JJ, Hulscher JB, Buskens CJ, Tilanus HW, ten Kate FJ, Obertop H (2001) Hospital volume and hospital mortality for esophagectomy. Cancer 91:1574–1578

    Article  PubMed  Google Scholar 

  • Van Raemdonck D, Van Cutsem E, Menten J, Ectors N, Coosemans W, De Leyn P, Lerut T (1997) Induction therapy for clinical T4 oesophageal carcinoma; a plea for continued surgical exploration. Eur J Cardiothorac Surg 11:828–837

    Article  PubMed  Google Scholar 

  • Van Vliet EP, Eijkemans MJ et al (2006) Staging of esophageal carcinoma in a low-volume EUS center compared with results from high-volume centers. Gastrointest Endosc 63:938–947

    Article  PubMed  Google Scholar 

  • Van Vliet EP, Hermans JJ, De Wever W, Eijkemans MJ, Steyerberg EW, Faasse C, van Helmond EP, de Leeuw AM, Sikkenk AC, de Vries AR, de Vries EH, Kuipers EJ, Siersema PD (2008) Radiologist experience and CT examination quality determine metastasis detection in patients with esophageal or gastric cardia cancer. Eur Radiol 18:2475–2484

    Article  PubMed  Google Scholar 

  • Vrouenraets BC, van Lanschot JJB (2006) Extent of surgical resection for esophageal and gastroesophageal junction adenocarcinomas. Surg Oncol Clin N Am 15:781–791

    Article  PubMed  Google Scholar 

  • Walsh T, Noonan N, Hollywood D et al (1996) Comparison of multimodal therapy and surgery for oesophageal adenocarcinoma. N Engl J Med 335:462–467

    Article  PubMed  CAS  Google Scholar 

  • Wittekind C, Green FL, Henson DE, Hutter RVP, Sobin LH (2003) TNM supplement: a commentary on uniform use, 3rd edn. Wiley-Liss, New-York

    Book  Google Scholar 

  • Yamamoto S, Kawahara K, Maekawa T, Shiraishi T, Shirakusa T (2005) Minimally invasive esop­hagectomy for stage I and II esopageal cancer. Ann Thor Surg 80:2070–2075

    Article  Google Scholar 

  • Zher KJ, Dawson PB, Yang SC, Heitmiller RF (1998) Standardized clinical care pathways for major thoracic cases reduces hospital costs. Ann Thorac Surg 66:914–919

    Article  Google Scholar 

  • Zuccaro G, Rice TW, Vargo JJ et al (2005) Endoscopic ultrasound errors in esophageal cancer. Am J Gastroenterol 100:1216 (The authors describe the difficulties in discriminating between pT1b-T2 and pT3-T4 withpT3-T4 with misclassification by EUS of disease extent in 15%)

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Thoracic and Esophageal Surgery, University Hospitals Leuven, 3000, Leuven, Belgium

    Toni Lerut

Authors
  1. Toni Lerut
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Georges Decker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Willy Coosemans
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paul De Leyn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Herbert Decaluwé
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Philippe Nafteux
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dirk Van Raemdonck
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Toni Lerut .

Editor information

Editors and Affiliations

  1. Klinik für Viszeral- und, Transplantationschirurgie, Universitätsspital Zürich, Rämistr. 100, Zürich, 8091, Switzerland

    Paul M. Schneider

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Lerut, T. et al. (2009). Quality Indicators of Surgery for Adenocarcinoma of the Esophagus and Gastroesophageal Junction. In: Schneider, P. (eds) Adenocarcinoma of the Esophagogastric Junction. Recent Results in Cancer Research, vol 182. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-70579-6_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-70579-6_11

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-70578-9

  • Online ISBN: 978-3-540-70579-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation