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Identifying a core symptom set triggering radiological and endoscopic investigations for suspected recurrent esophago-gastric cancer : a modified Delphi consensus process |
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| Author: | Chidambaram, Swathikan1; Patel, Nikhil M.1; Sounderajah, Viknesh1; |
| Organizations: |
1Department of Surgery and Cancer, Imperial College London, London, UK 2Department of Surgical Oncology, Veneto Institute of Oncology-IRCCS, Padova, Italy 3Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS Padua, Italy
4Department of Upper Gastrointestinal Surgery, Norfolk and Norwich University Hospital, Norwich, UK
5Department of Upper Gastrointestinal Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK 6Department of Thoracic Surgery, Aix-Marseille University, North Hospital, Marseille, France 7Department of Thoracic Surgery and Upper Gastrointestinal Surgery, McGill University, Montréal, Canada 8Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, Birmingham, UK 9Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK 10Department of General Surgery, University of Mainz, Mainz, Germany 11Digestive Surgery, CHU of Bordeaux, Bordeaux, France 12Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland 13Section of Gastrointestinal Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden 14Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden 15Department of Surgery, Oulu University Hospital, University of Oulu, Oulo, Finland 16Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands 17Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, Seattle, WA, USA 18Department of Thoracic Surgery, Katholieke Universiteit Leuven, Leuven, Belgium 19Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands 20Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden 21Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden 22Department of Surgery, San Raffaele Hospital, Milan, Italy 23Department of General, Visceral, Cancer and Transplantation Surgery, University of Cologne, Cologne, Germany 24Upper GI and Soft Tissue Unit, Academy of Surgery, Princess Alexandra Hospital, Faculty of Medicine, University of Queens- land, Brisbane, Australia 25Department of Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands 26Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands 27Discipline of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, Australia 28Department of Surgery, Flinders Medical Center, Adelaide, Australia 29Department of Esophagogastric Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK 30Department of Upper GI Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK |
| Format: | article |
| Version: | published version |
| Access: | open |
| Online Access: | PDF Full Text (PDF, 0.8 MB) |
| Persistent link: | http://urn.fi/urn:nbn:fi-fe2023080994472 |
| Language: | English |
| Published: |
John Wiley & Sons,
2022
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| Publish Date: | 2023-08-09 |
| Description: |
SummaryBackground: There is currently a lack of evidence-based guidelines regarding surveillance for recurrence after esophageal and gastric (OG) cancer surgical resection, and which symptoms should prompt endoscopic or radiological investigations for recurrence. The aim of this study was to develop a core symptom set using a modified Delphi consensus process that should guide clinicians to carry out investigations to look for suspected recurrent OG cancer in previously asymptomatic patients. Methods: A web-based survey of 42 questions was sent to surgeons performing OG cancer resections at high volume centers. The first section evaluated the structure of follow-up and the second, determinants of follow-up. Two rounds of a modified Delphi consensus process and a further consensus workshop were used to determine symptoms warranting further investigations. Symptoms with a 75% consensus agreement as suggestive of recurrent cancer were included in the core symptom set. Results: 27 surgeons completed the questionnaires. A total of 70.3% of centers reported standardized surveillance protocols, whereas 3.7% of surgeons did not undertake any surveillance in asymptomatic patients after OG cancer resection. In asymptomatic patients, 40.1% and 25.9% of centers performed routine imaging and endoscopy, respectively. The core set that reached consensus, consisted of eight symptoms that warranted further investigations included; dysphagia to solid food, dysphagia to liquids, vomiting, abdominal pain, chest pain, regurgitation of foods, unexpected weight loss and progressive hoarseness of voice. Conclusion: There is global variation in monitoring patients after OG cancer resection. Eight symptoms were identified by the consensus process as important in prompting radiological or endoscopic investigation for suspected recurrent malignancy. Further randomized controlled trials are necessary to link surveillance strategies to survival outcomes and evaluate prognostic value. see all
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| Series: |
Diseases of the esophagus |
| ISSN: | 1120-8694 |
| ISSN-E: | 1442-2050 |
| ISSN-L: | 1120-8694 |
| Volume: | 36 |
| Issue: | 1 |
| Article number: | doac038 |
| DOI: | 10.1093/dote/doac038 |
| OADOI: | https://oadoi.org/10.1093/dote/doac038 |
| Type of Publication: |
A1 Journal article – refereed |
| Field of Science: |
3126 Surgery, anesthesiology, intensive care, radiology |
| Subjects: | |
| Copyright information: |
© The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
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https://creativecommons.org/licenses/by/4.0/ |