Diagnostic evaluation, surgical technique, and perioperative management after esophagectomy: consensus statement of the German Advanced Surgical Treatment Study Group |
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Authors: | Daniel Palmes Matthias Br��wer Franz G Bader Michael Betzler Heinz Becker Hans-Peter Bruch Markus B��chler Heinz Buhr �� Michael Ghadimi Ulrich T Hopt Ralf Konopke Katja Ott Stefan Post J?rg-Peter Ritz Ulrich Ronellenfitsch Hans-Detlev Saeger Norbert Senninger |
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Institution: | 1. Department of General and Visceral Surgery, University of M??nster, Waldeyerstrasse 1, 48149, M??nster, Germany 2. Department of Surgery, University of Schleswig Holstein, Campus L??beck, L??beck, Germany 3. Department of Surgery, Alfried Krupp Hospital, Essen, Germany 6. Department of General and Visceral Surgery, G?ttingen University Medical Center, G?ttingen, Germany 4. Department of Surgery, University of Heidelberg, Heidelberg, Germany 5. Department of General, Vascular and Thoracic Surgery, Charit????Campus Benjamin Franklin, Berlin, Germany 7. Department of General and Visceral Surgery, University of Freiburg, Freiburg im Breisgau, Germany 8. Department of General, Thoracic and Vascular Surgery, School of Medicine, Dresden University of Technology, Dresden, Germany 9. Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
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Abstract: | Purpose Correct diagnosis, surgical treatment, and perioperative management of patients with esophageal carcinoma remain crucial for prognosis within multimodal treatment procedures. This study aims to achieve a consensus regarding current management strategies in esophageal cancer by questioning a panel of experts from the German Advanced Surgical Treatment Study (GAST) group, comprised of 9 centers specialized in esophageal surgery, with a combined total of >220 esophagectomies per year. Materials and methods The Delphi method, a systematic and interactive, evidence-based approach, was used to obtain consensus statements from the GAST group regarding ambiguities and disparities in diagnosis, patient selection, surgical technique, and perioperative management of patients with esophageal carcinoma. After four rounds of surveys, agreement was measured by Likert scales and defined as full (100% agreement), near (??66.6% agreement), or no consensus (<66.6% agreement). Results Full or near consensus was obtained for essential aspects of esophageal cancer staging, proper surgical technique, perioperative management and indication for primary surgery, and neoadjuvant treatment or palliative treatment. No consensus was achieved regarding acceptability of minimally invasive technique and postoperative nutrition after esophagectomy. Conclusion The GAST consensus statement represents a position paper for treatment of patients with esophageal carcinoma which both contributes to the development of clinical treatment guidelines and outlines topics in need of further clinical studies. |
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