Our Summary

This study aimed to find out if regularly monitoring (active surveillance) can be an alternative to surgery for individuals who show no signs of esophageal cancer after undergoing chemotherapy and radiotherapy. The study was conducted in 12 hospitals in the Netherlands and included individuals with advanced esophageal cancer, who had no detectable tumor after undergoing treatment. These individuals were either monitored or underwent standard surgery. The main focus was on their survival rate.

The researchers found that the 2-year survival rate for individuals who were monitored was not significantly worse than for those who had surgery. There were also no significant differences in the number of complications or deaths after surgery between the two groups. This suggests that for some individuals, being monitored rather than having surgery could be an option. However, more research is needed to confirm these findings over a longer period. The results of this study could help patients and doctors make decisions about treatment. The study was funded by the Dutch Cancer Society and the Netherlands Organisation for Health Research and Development.

FAQs

  1. What was the aim of the study on esophagectomy?
  2. What were the findings of the study regarding the survival rate of individuals who were monitored versus those who underwent surgery?
  3. Is active surveillance a viable alternative to surgery for individuals with no detectable esophageal cancer after treatment, according to the study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about esophagectomy is to carefully follow post-operative instructions, including dietary guidelines and physical activity recommendations, to aid in a successful recovery and minimize complications. It is also important to attend follow-up appointments and communicate any concerns or symptoms experienced after surgery with your healthcare provider.

Suitable For

Patients who are typically recommended for esophagectomy include those with early-stage esophageal cancer that has not spread beyond the esophagus, those with precancerous conditions such as Barrett’s esophagus that have a high risk of developing into cancer, and those with advanced esophageal cancer that has not responded to other treatments such as chemotherapy and radiation therapy. This study suggests that for some individuals with advanced esophageal cancer who have responded well to chemotherapy and radiation therapy, active surveillance may be a viable alternative to surgery.

Timeline

Before esophagectomy:

  1. Patient undergoes chemotherapy and radiotherapy to treat advanced esophageal cancer.
  2. Patient shows no signs of tumor after treatment.
  3. Patient is evaluated to determine if surgery is necessary.
  4. Patient may be given the option of active surveillance or surgery.

After esophagectomy:

  1. If patient chooses surgery, they undergo the procedure to remove part or all of the esophagus.
  2. Patient is monitored for complications and recovery post-surgery.
  3. Patient may experience side effects such as difficulty swallowing, reflux, or weight loss.
  4. Patient undergoes regular follow-up appointments and tests to monitor for recurrence of cancer.
  5. Patient’s long-term survival rate is monitored to assess the effectiveness of treatment.

What to Ask Your Doctor

  1. What are the potential risks and benefits of undergoing an esophagectomy compared to active surveillance?

  2. How will my quality of life be affected by surgery versus monitoring?

  3. What are the long-term outcomes and survival rates for patients who undergo surgery versus monitoring?

  4. Are there any alternative treatment options available for me besides surgery or monitoring?

  5. What factors should I consider when deciding between surgery and monitoring for my esophageal cancer?

  6. How often will I need to be monitored if I choose active surveillance, and what will that monitoring entail?

  7. What are the potential complications or side effects of esophagectomy that I should be aware of?

  8. How experienced is the surgical team in performing esophagectomies, and what is their success rate?

  9. Are there any specific lifestyle changes or precautions I should take after undergoing surgery or choosing monitoring?

  10. Are there any ongoing clinical trials or research studies that I may be eligible for to explore new treatment options for esophageal cancer?

Reference

Authors: van der Wilk BJ, Eyck BM, Wijnhoven BPL, Lagarde SM, Rosman C, Noordman BJ, Valkema MJ, Bisseling TM, Coene PLO, van Det MJ, Dekker JWT, van Dieren JM, Doukas M, van Esser S, Fiets WE, Hartgrink HH, Heisterkamp J, Holster IL, Klarenbeek B, van Klaveren D, Kouw E, Kouwenhoven EA, Luyer MD, Mostert B, Nieuwenhuijzen GAP, Oostenbrug LE, Pierie JP, van Sandick JW, Sosef MN, Spaander MCW, Valkema R, van der Zaag ES, Steyerberg EW, van Lanschot JJB; SANO Study Group. Journal: Lancet Oncol. 2025 Apr;26(4):425-436. doi: 10.1016/S1470-2045(25)00027-0. Epub 2025 Mar 17. PMID: 40112851