Identifying a core symptom set triggering radiological and endoscopic investigations for suspected recurrent esophago-gastric cancer: a modified Delphi consensus process

Swathikan Chidambaram, Nikhil M. Patel, Viknesh Sounderajah, Rita Alfieri, Luigi Bonavina, Edward Cheong, Andy Cockbain, Xavier Benoit D'Journo, Lorenzo Ferri, Ewen A. Griffiths, Peter Grimminger, Caroline Gronnier, Christian Gutschow, Jakob Hedberg, Joonas H. Kauppila, Sjoerd Lagarde, Donald Low, Philippe Nafteux, Grard Nieuwenhuijzen, Magnus NilssonRiccardo Rosati, Wolfgang Schroeder, B. Mark Smithers, Mark I. van Berge Henegouwen, Richard van Hillegesberg, David I. Watson, Ravinder Vohra, Nick Maynard, Sheraz R. Markar*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

BACKGROUND: 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.

Original languageEnglish
Article numberdoac038
JournalDiseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
Volume36
Issue number1
Early online date21 Jul 2021
DOIs
Publication statusPublished - 1 Jan 2023

Bibliographical note

Publisher Copyright:
© The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus.

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