Neoadjuvant radiochemotherapy based on the CROSS regimen is now widely adopted as the standard of care for esophageal cancer; with this regimen nearly half of patients with squamous cell carcinoma and 20% to 30% of patients with adenocarcinoma will have a complete pathological response (pCR), raising the question if an esophageal resection is still indicated in such patients. The article “Active surveillance in clinically complete responders after neoadjuvant chemoradiotherapy for esophageal or junctional cancer”1 reviews the current literature on this topic: four retrospective studies only were individuated, all of them consistently showing that the survival rate did not differ after clinical CR between those operated on and those left in an active surveillance program. However, the majority of patients who did not received surgery were unfit or refused it. Two RCTs (ESOSTRATE in France and SANO –Surgery As Needed for Oesophageal cancer- have now been initiated and both expect reseults in 2023.
1. Noordman BJ, Wijnhoven BPL, Lagarde SM, Biermann K et al. Diseases of The Esophagus 2017; December Issue
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How to manage an esophageal leak due to spontaneous (Boherhave) or iatrogenic perforation or after esophageal anastomosis remains a controversial topic. In this article “Outcome following the main treatment options in patients with a leaking esophagus: a systematic literature review”2 the Authors perform a systematic review to compare the two most used treatments: insertion of a self expandable metal stent and surgical repair. From 2005 to 2015 they selected 17 articles for a total of 371 patients treated with SEMS and 368 treated with direct or reinforced suture. The success rate was similar (88% vs 83%) with an in-hospital mortality of 7.5% for SEMS and 17% for surgery, suggesting that SEMS could be safely used to seal an esophageal leak, provided that less than48 hours elapsed from the leak and the positioning of the stent.
2. Persson S, Fouvelais I, Irino T, Lundell L. Diseases of the Esophagus 2017; December Issue
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