Introduction Clear evidence exists for a survival benefit from both preoperative chemotherapy (pCT) and chemoradiotherapy (pCRT) in selected patients with oesophageal adenocarcinoma. Due to national and international disagreement on the optimal preoperative treatment we performed a survey of the opinions among experienced oesophagogastric surgeons.
Method 12 questions were posted on Survey Monkey and sent electronically to all members of AUGIS (Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland) and ANZGOSA (Australia and New Zealand Gastro-Oesophageal Surgeons Association). Replies were analysed at 30 days. Significance was calculated using Fisher’s exact test.
Results There were 74 responses. No members of ANZGOSA worked in units performing >60 oesophagectomies per year compared to 50% of AUGIS members (P= <0.0001). A 2-field lymphadenectomy was routinely performed by 77% of AUGIS members and 47% of ANZGOSA members (P = 0.0142). No significant differences existed between both groups with respect to the recommended treatment of node-negative tumours irrespective of T stage.
For both groups pCT was the preferred treatment option for T3N0 lesions (57% ANZGOSA and 58% AUGIS). This did not change for T3N1/2 lesions in the AUGIS group but the percentage of ANZGOSA members recommending pCT fell from 57% to 35% (P = 0.0924) with pCRT the favoured treatment option. No agreement existed on how best to treat T3N3 lesions. 85% of ANZGOSA members felt less restricted to the options for therapy compared with 57% of AUGIS members (P = 0.0231). The inability to offer pCRT in selected cases was the main restriction stated by 37% of AUGIS members compared to 0% in ANZGOSA (P = 0.0004).
Conclusion This survey reveals evidence of centralisation within the UK compared to Australasia but with more restricted treatment options. UK surgeons adopt a more radical surgical approach but a less aggressive oncological approach than ANZGOSA members. The treatment of T3N3 disease remains an unresolved problem.
Disclosure of interest None Declared.
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