Treatment allocation and evolving surgical strategies in gastroesophageal cancer

Worldwide, over 1.5 million new gastroesophageal cancer cases were reported in 2020. The survival of gastroesophageal cancer is poor, and the prognosis is primarily determined by the possibilities for curative treatment. In absence of tumor infiltration into surrounding organs and distant metastasis, patients may be treated with curative intent. However, almost half of all Dutch patients with gastric cancer, and almost 40% of all Dutch patients with esophageal cancer present with advanced disease no longer eligible for curative treatment.
For early stage disease, i.e. superficial node-negative tumors, an endoscopic resection can be performed. For others with potentially curable disease, a surgical resection (i.e. esophagectomy or gastrectomy) in combination with multimodal treatment can be considered. Although these curative treatment options are described in international guidelines, a previous study stated that the majority of patients with esophageal cancer did not receive guideline-concordant treatment.
The chapters included in this thesis aimed to describe the evolving surgical strategies for (gastro)esophageal cancer, their outcomes, and the interpatient differences in allocation to these treatment options in daily clinical practice. By reporting the intersex and intercountry differences in treatment allocation and survival, we hope to highlight the importance of international shared (curative) treatment strategies and, in parallel, stimulate personalized gastroesophageal cancer care. Moreover, by investigating the nationwide trends in care and comparing outcomes after different surgical procedures and approaches, we provide an overview of current evidence-based treatment outcomes for physicians involved in gastroesophageal cancer care.