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Implementation of Staging Guidelines in Early Esophageal Cancer: A Study of the Society of Thoracic Surgeons General Thoracic Surgery Database.
Reza, Joseph A; Raman, Vignesh; Vekstein, Andrew; Grau-Sepulveda, Maria; Burfeind, William P; Chin, Kristine; Petrov, Roman; Erkmen, Cherie P.
Afiliação
  • Reza JA; Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA.
  • Raman V; Department of Cardiovascular and Thoracic Surgery, Duke University, Durham, NC.
  • Vekstein A; Department of Cardiovascular and Thoracic Surgery, Duke University, Durham, NC.
  • Grau-Sepulveda M; Department of Cardiovascular and Thoracic Surgery, Duke University, Durham, NC.
  • Burfeind WP; Division of Thoracic Surgery, St. Luke's University Health Network, Bethlehem, PA.
  • Chin K; Center for Asian Health, Temple University, Philadelphia, PA.
  • Petrov R; Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA.
  • Erkmen CP; Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA.
Ann Surg ; 278(4): e754-e759, 2023 10 01.
Article em En | MEDLINE | ID: mdl-36912032
OBJECTIVE: To evaluate the adoption and clinical impact of endoscopic resection (ER) in early esophageal cancer. BACKGROUND: Staging for early esophageal cancer is largely inaccurate. Assessment of the impact of ER on staging accuracy is unknown, as is the implementation of ER. METHODS: We 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. RESULTS: For 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). CONCLUSIONS: The 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.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Cirurgia Torácica / Neoplasias Esofágicas / Cirurgiões Tipo de estudo: Diagnostic_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Limite: Humans Idioma: En Revista: Ann Surg Ano de publicação: 2023 Tipo de documento: Article País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Cirurgia Torácica / Neoplasias Esofágicas / Cirurgiões Tipo de estudo: Diagnostic_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Limite: Humans Idioma: En Revista: Ann Surg Ano de publicação: 2023 Tipo de documento: Article País de publicação: Estados Unidos