Preoperative management of patients with oesophageal cancer: expert recommendations.

Abstract

The aim of this work is to establish recommendations for the preoperative evaluation and selection of patients with malignant oesophageal neoplasms, who are candidates for surgical resection with curative intent, based on the consensus established by a group of experts. Using the Delphi methodolgy and after 2 rounds of evaluation, responses were obtained from 37 experts to 47 questions about the preoperative management of oesophageal cancer, considering consensus if there was a mean score greater than 8 (range between 0 to 10). Of the respondents, 54% were women, with a mean age of 50.2 years, with more than 15 years of average experience in oesophageal surgery. In the preoperative evaluation, agreement was obtained on most of the recommendations, with the indication of a staging laparoscopy being the only one where it was not reached. In the preoperative optimisation, agreement was reached on nutritional, anaemia, physical status, respiratory and comorbidities evaluation, but no agreement was reached on recommending immunonutrition or echocardiography routinely. In the inoperability criteria were included ECOG greater than 1, impaired lung function, and/or Child B or C liver cirrhosis. Agreement was reached on considering unresectable tumors with invasion of the tracheobronchial tract, large vessels, and spinal column, multivisceral metastases, and/or peritoneal carcinomatosis. Therefore, the recommendations established in this manuscript may be useful to support decision-making in daily clinical practice, with a high degree of consensus that decisions regarding the management of these patients should be made on an individual basis and within a multidisciplinary committee of experts.