New S3 guideline for esophageal cancer : Important surgical aspects

• Published in: Chirurg 2016-10, Vol.87 (10), p.865-872
• Main Authors: Hölscher, A H, Stahl, M, Messmann, H, Stuschke, M, Meyer, H J, Porschen, R
• Format: Article
• Language: ger
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - pathology; Adenocarcinoma - therapy; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Chemotherapy, Adjuvant; Consensus; Diagnostic Imaging - methods; Endoscopy, Digestive System; Endosonography; Esophageal Neoplasms - diagnosis; Esophageal Neoplasms - pathology; Esophageal Neoplasms - therapy; Esophagectomy - methods; Evidence-Based Medicine; Guideline Adherence; Humans; Lymph Node Excision - methods; Minimally Invasive Surgical Procedures - methods; Neoplasm Staging; Palliative Care - methods
• ISSN: 1433-0385
• DOI: 10.1007/s00104-016-0214-1

The current German S3 guideline represents the recommendations for the diagnosis and therapy of squamous cell carcinomas and adenocarcinomas of the esophagus based on evidence from the literature and interdisciplinary expert consensus. Esophagogastroscopy with biopsy, endosonography, and spiral CT scan of the neck, thorax, and abdomen are decisive in staging and the choice of therapy. For a curative approach, surgery, especially transthoracic esophagectomy and gastric pull-up, is the most important therapeutic option, except in the case of mucosal carcinomas or cervical squamous cell carcinomas. The significance of total minimally invasive esophageal resection or a hybrid technique is still uncertain. In category cT3 or resectable cT4 tumors, neoadjuvant radiochemotherapy should be performed in squamous cell carcinomas or adenocarcinomas. Alternatively, perioperative chemotherapy can be carried out in adenocarcinoma. Palliative resections should be avoided and replaced by interventional procedures for palliation.