Top

30-03-2017 | Esophageal cancer | Article

Multidisciplinary Approach to the Management of Esophageal Malignancies

Journal: World Journal of Surgery

Authors: Ranjit Joseph, Shachar Laks, Michael Meyers, Autumn J. McRee

Publisher: Springer International Publishing

Abstract

Introduction

A multidisciplinary approach in the management of complex malignancies is becoming more common, and likewise, adopting such an approach to the care of patients with locally advanced esophageal is recommended in order to optimize clinical outcomes.

Methods

In this review, we discuss both the surgical and medical oncology perspectives in the management of patients with locally advanced esophageal cancer. We review the data supporting the current standard-of-care approach, namely trimodality therapy with neoadjuvant chemo-radiotherapy followed by surgery. Other aspects of managing these patients including the control of dysphagia and pain as well as nutritional support are discussed. Finally, we review data that support the importance of incorporating a multidisciplinary streamlined approach in the management of these patients.

Results

Rather than having patients see each provider separately, a multidisciplinary approach to esophageal cancer allows for the seamless flow of communication and proactive management of the patient’s symptoms. These benefits include increasing the likelihood of evidence-based decision making, shorter time to treatment, and increased patient quality of life, all of which can result in improved patient outcomes.

Conclusion

The use of a multidisciplinary team can lead to a more accurate staging paradigm and thereby, better management decisions that translate to improved clinical outcomes. Therefore, optimizing the multidisciplinary approach for the care of patients with locally advanced esophageal cancer is essential for successful and individualized patient care.

Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA Cancer J Clin 66(1):7–30CrossRefPubMed

Pohl H, Sirovich B, Welch HG (2010) Esophageal adenocarcinoma incidence: are we reaching the peak? Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol 19(6):1468–1470CrossRef

Altorki N, Kent M, Ferrara C, Port J (2002) Three-field lymph node dissection for squamous cell and adenocarcinoma of the esophagus. Ann Surg 236(2):177–183CrossRefPubMedPubMedCentral

Nguyen NT, Hinojosa MW, Smith BR, Chang KJ, Gray J, Hoyt D (2008) Minimally invasive esophagectomy: lessons learned from 104 operations. Ann Surg 248(6):1081–1091CrossRefPubMed

Nafteux P, Moons J, Coosemans W, Decaluwe H, Decker G, De Leyn P, Van Raemdonck D, Lerut T (2011) Minimally invasive oesophagectomy: a valuable alternative to open oesophagectomy for the treatment of early oesophageal and gastro-oesophageal junction carcinoma. Eur J Cardio Thorac Surg Off J Eur Assoc Cardio Thorac Surg 40(6):1455–1463 (discussion 1463–1464)

Tapias LF, Morse CR (2012) A preliminary experience with minimally invasive Ivor Lewis esophagectomy. Dis Esophagus Off J Int Soc Dis Esophagus 25(5):449–455CrossRef

Sihag S, Wright CD, Wain JC, Gaissert HA, Lanuti M, Allan JS, Mathisen DJ, Morse CR (2012) Comparison of perioperative outcomes following open versus minimally invasive Ivor Lewis oesophagectomy at a single, high-volume centre. Eur J Cardio Thorac Surg Off J Eur Assoc Cardio Thorac Surg 42(3):430–437CrossRef

Luketich JD, Pennathur A, Awais O, Levy RM, Keeley S, Shende M, Christie NA, Weksler B, Landreneau RJ, Abbas G, Schuchert MJ, Nason KS (2012) Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg 256(1):95–103CrossRefPubMedPubMedCentral

Biere SS, van Berge Henegouwen MI, Maas KW, Bonavina L, Rosman C, Garcia JR, Gisbertz SS, Klinkenbijl JH, Hollmann MW, de Lange ES, Bonjer HJ, van der Peet DL, Cuesta MA (2012) Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet (London, England) 379(9829):1887–1892CrossRef

10.

Luketich JD, Pennathur A, Franchetti Y, Catalano PJ, Swanson S, Sugarbaker DJ, De Hoyos A, Maddaus MA, Nguyen NT, Benson AB, Fernando HC (2015) Minimally invasive esophagectomy: results of a prospective phase II multicenter trial-the eastern cooperative oncology group (E2202) study. Ann Surg 261(4):702–707CrossRefPubMedPubMedCentral

11.

Safranek PM, Cubitt J, Booth MI, Dehn TC (2010) Review of open and minimal access approaches to oesophagectomy for cancer. Br J Surg 97(12):1845–1853CrossRefPubMed

12.

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(15):1128–1137CrossRefPubMed

13.

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(22):2117–2127CrossRefPubMed

14.

Birkmeyer JD, Sun Y, Wong SL, Stukel TA (2007) Hospital volume and late survival after cancer surgery. Ann Surg 245(5):777–783CrossRefPubMedPubMedCentral

15.

Law SY, Fok M, Wong J (1996) Pattern of recurrence after oesophageal resection for cancer: clinical implications. Br J Surg 83(1):107–111CrossRefPubMed

16.

Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, Stalmeier PF, ten Kate FJ, van Dekken H, Obertop H, Tilanus HW, van Lanschot JJ (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347(21):1662–1669CrossRefPubMed

17.

Kelsen DP, Ginsberg R, Pajak TF, Sheahan DG, Gunderson L, Mortimer J, Estes N, Haller DG, Ajani J, Kocha W, Minsky BD, Roth JA (1998) Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med 339(27):1979–1984CrossRefPubMed

18.

Urba SG, 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 Off J Am Soc Clin Oncol 19(2):305–313CrossRef

19.

Oppedijk V, van der Gaast A, van Lanschot JJ, van Hagen P, van Os R, van Rij CM, van der Sangen MJ, Beukema JC, Rutten H, Spruit PH, Reinders JG, Richel DJ, van Berge Henegouwen MI, Hulshof MC (2014) Patterns of recurrence after surgery alone versus preoperative chemoradiotherapy and surgery in the CROSS trials. J Clin Oncol Off J Am Soc Clin Oncol 32(5):385–391CrossRef

20.

Herskovic A, Martz K, Al-Sarraf M, Leichman L, Brindle J, Vaitkevicius V, Cooper J, Byhardt R, Davis L, Emami B (1992) Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med 326(24):1593–1598CrossRefPubMed

21.

Cooper JS, Guo MD, Herskovic A, Macdonald JS, Martenson JA Jr., Al-Sarraf M, Byhardt R, Russell AH, Beitler JJ, Spencer S, Asbell SO, Graham MV, Leichman LL (1999) Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA 281(17):1623–1627CrossRefPubMed

22.

Minsky BD, Pajak TF, Ginsberg RJ, Pisansky TM, Martenson J, Komaki R, Okawara G, Rosenthal SA, Kelsen DP (2002) INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol Off J Am Soc Clin Oncol 20(5):1167–1174CrossRef

23.

Bedenne L, Michel P, Bouche O, Milan C, Mariette C, Conroy T, Pezet D, Roullet B, Seitz JF, Herr JP, 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 Off J Am Soc Clin Oncol 25(10):1160–1168CrossRef

24.

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 with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med 337(3):161–167CrossRefPubMed

25.

Tepper J, Krasna MJ, Niedzwiecki D, Hollis D, Reed CE, Goldberg R, Kiel K, Willett C, Sugarbaker D, Mayer R (2008) Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol Off J Am Soc Clin Oncol 26(7):1086–1092CrossRef

26.

Shapiro J, van Lanschot JJ, Hulshof MC, van Hagen P, van Berge Henegouwen MI, Wijnhoven BP, van Laarhoven HW, Nieuwenhuijzen GA, Hospers GA, Bonenkamp JJ, Cuesta MA, Blaisse RJ, Busch OR, Ten Kate FJ, Creemers GJ, Punt CJ, Plukker JT, Verheul HM, Bilgen EJ, van Dekken H, van der Sangen MJ, Rozema T, Biermann K, Beukema JC, Piet AH, van Rij CM, Reinders JG, Tilanus HW, Steyerberg EW, van der Gaast A (2015) Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol 16(9):1090–1098CrossRefPubMed

27.

Urschel JD, Vasan H (2003) A meta-analysis of randomized controlled trials that compared neoadjuvant chemoradiation and surgery to surgery alone for resectable esophageal cancer. Am J Surg 185(6):538–543CrossRefPubMed

28.

Fiorica F, Di Bona D, Schepis F, Licata A, Shahied L, Venturi A, Falchi AM, Craxi A, Camma C (2004) Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysis. Gut 53(7):925–930CrossRefPubMedPubMedCentral

29.

Jin HL, Zhu H, Ling TS, Zhang HJ, Shi RH (2009) Neoadjuvant chemoradiotherapy for resectable esophageal carcinoma: a meta-analysis. World J Gastroenterol 15(47):5983–5991CrossRefPubMedPubMedCentral

30.

Wang DB, Zhang X, Han HL, Xu YJ, Sun DQ, Shi ZL (2012) Neoadjuvant chemoradiotherapy could improve survival outcomes for esophageal carcinoma: a meta-analysis. Dig Dis Sci 57(12):3226–3233CrossRefPubMed

31.

Ronellenfitsch U, Schwarzbach M, Hofheinz R, Kienle P, Kieser M, Slanger TE, Burmeister B, Kelsen D, Niedzwiecki D, Schuhmacher C, Urba S, van de Velde C, Walsh TN, Ychou M, Jensen K (2013) Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: systematic review with meta-analysis combining individual patient and aggregate data. Eur J Cancer (Oxford, England 1990) 49(15):3149–3158CrossRef

32.

Pasquali S, Yim G, Vohra RS, Mocellin S, Nyanhongo D, Marriott P, Geh JI, Griffiths EA (2017) Survival after neoadjuvant and adjuvant treatments compared to surgery alone for resectable esophageal carcinoma: a network meta-analysis. Ann Surg 265(3):481–491CrossRefPubMed

33.

Nagaraja V, Cox MR, Eslick GD (2014) Safety and efficacy of esophageal stents preceding or during neoadjuvant chemotherapy for esophageal cancer: a systematic review and meta-analysis. J Gastrointest Oncol 5(2):119–126PubMedPubMedCentral

34.

Gregg JR, Cookson MS, Phillips S, Salem S, Chang SS, Clark PE, Davis R, Stimson CJ Jr., Aghazadeh M, Smith JA Jr., Barocas D (2011) Effect of preoperative nutritional deficiency on mortality after radical cystectomy for bladder cancer. J Urol 185(1):90–96CrossRefPubMed

35.

Kathiresan AS, Brookfield KF, Schuman SI, Lucci JA 3rd (2011) Malnutrition as a predictor of poor postoperative outcomes in gynecologic cancer patients. Arch Gynecol Obstet 284(2):445–451CrossRefPubMed

36.

Garth AK, Newsome CM, Simmance N, Crowe TC (2010) Nutritional status, nutrition practices and post-operative complications in patients with gastrointestinal cancer. J Hum Nutr Diet Off J Br Diet Assoc 23(4):393–401CrossRef

37.

Sungurtekin H, Sungurtekin U, Balci C, Zencir M, Erdem E (2004) The influence of nutritional status on complications after major intraabdominal surgery. J Am Coll Nutr 23(3):227–232CrossRefPubMed

38.

Di Fiore F, Lecleire S, Pop D, Rigal O, Hamidou H, Paillot B, Ducrotte P, Lerebours E, Michel P (2007) Baseline nutritional status is predictive of response to treatment and survival in patients treated by definitive chemoradiotherapy for a locally advanced esophageal cancer. Am J Gastroenterol 102(11):2557–2563CrossRefPubMed

39.

Stockeld D, Tennvall J, Wagenius G, Albertsson M, Backman L, Brodin O, Cwikiel M, Granstrom L, Gustafsson G, Gustavsson S, Hambraeus G, Lewensohn R, Sjostedt S, Strander H, Aberg B, Fagerberg J (2001) A Swedish study of chemoradiation in squamous cell carcinoma of the esophagus. Acta oncologica (Stockholm, Sweden) 40(5):566–573CrossRef

40.

Daly JM, Weintraub FN, Shou J, Rosato EF, Lucia M (1995) Enteral nutrition during multimodality therapy in upper gastrointestinal cancer patients. Ann Surg 221(4):327–338CrossRefPubMedPubMedCentral

41.

Margolis M, Alexander P, Trachiotis GD, Gharagozloo F, Lipman T (2003) Percutaneous endoscopic gastrostomy before multimodality therapy in patients with esophageal cancer. Ann Thorac Surg 76(5):1694–1697 (discussion 1697–1698) CrossRefPubMed

42.

Jenkinson AD, Lim J, Agrawal N, Menzies D (2007) Laparoscopic feeding jejunostomy in esophagogastric cancer. Surg Endosc 21(2):299–302CrossRefPubMed

43.

Ohnmacht GA, Allen MS, Cassivi SD, Deschamps C, Nichols FC 3rd, Pairolero PC (2006) Percutaneous endoscopic gastrostomy risks rendering the gastric conduit unusable for esophagectomy. Dis Esophagus Off J Int Soc Dis Esophagus 19(4):311–312CrossRef

44.

Joseph M, Meyers MO (2010) Laparoscopic-assisted percutaneous gastrostomy tube placement in the initial management of resectable esophageal and gastroesophageal junction carcinoma. J Am Coll Surg 211(4):e21–e24CrossRefPubMed

45.

Galan M, Farran L, Aliste L, Hormigo G, Aranda H, Bettonica C, Boladeras AM, Botargues JM, Calvo M, Creus G, De Lama ME, Gornals JB, Mast R, Miro M, Paules MJ, Robles J, Virgili N, Borras JM (2015) Multidisciplinary cancer care may impact on the postoperative mortality and survival of patients with oesophageal and oesophagogastric junction cancer: a retrospective cohort study. Clin Transl Oncol Off Publ Fed Span Oncol Soc Natl Cancer Inst Mex 17(3):247–256

46.

Stephens MR, Lewis WG, Brewster AE, Lord I, Blackshaw GR, Hodzovic I, Thomas GV, Roberts SA, Crosby TD, Gent C, Allison MC, Shute K (2006) Multidisciplinary team management is associated with improved outcomes after surgery for esophageal cancer. Dis Esophagus Off J Int Soc Dis Esophagus 19(3):164–171CrossRef

47.

Meguid C, Schulick RD, Schefter TE, Lieu CH, Boniface M, Williams N, Vogel JD, Gajdos C, McCarter M, Edil BH (2016) The multidisciplinary approach to gi cancer results in change of diagnosis and management of patients. multidisciplinary care impacts diagnosis and management of patients. Ann Surg Oncol 23(12):3986–3990CrossRefPubMed