The 2025 American Association for Thoracic Surgery (AATS) expert consensus document: Surgical management of esophageal and gastroesophageal junction cancer
- PMID: 40328426
- DOI: 10.1016/j.jtcvs.2025.04.009
The 2025 American Association for Thoracic Surgery (AATS) expert consensus document: Surgical management of esophageal and gastroesophageal junction cancer
Abstract
Objective: Esophagectomy has been a cornerstone of the treatment of nonmetastatic esophageal cancer, but its use has evolved with advances in endoscopic resection techniques, systemic therapy, and radiation. This document reviews the existing literature and reports multidisciplinary consensus and specific recommendations on how best to treat esophageal and gastroesophageal junction cancer at different stages, including difficult clinical scenarios.
Methods: The American Association for Thoracic Surgery Clinical Practice Standards Committee assembled an international, multidisciplinary panel of gastroenterologists, medical oncologists, radiation oncologists, surgical oncologists, and thoracic surgeons with established esophageal and gastroesophageal junction cancer management expertise. A focused literature review was performed with the assistance of a medical librarian. The panel used a modified Delphi method to develop expert consensus statements with a class of recommendations and level of evidence for 3 topics: early-stage adenocarcinoma, locally advanced adenocarcinoma, and squamous cell carcinoma.
Results: Consensus was reached on 23 recommendations, reflecting insights on the basis of the latest literature and current clinical experience that focused on disease stage and histology. The recommendations provide input on the role of surgery, endoscopic therapy, and surveillance for early-stage adenocarcinoma, how to best combine surgery with multimodality therapy for locally advanced adenocarcinoma, and when surgery should be used for patients with squamous cell carcinoma.
Conclusions: Despite the complex nature of esophageal cancer management, consensus on several key recommendations was achieved by this American Association for Thoracic Surgery expert panel. These recommendations, determined on the basis of evidence and developed using the modified Delphi method and expert opinion, provide guidance for thoracic surgeons and other medical professionals who care for esophageal cancer patients.
Keywords: adenocarcinoma; esophageal cancer; squamous cell carcinoma.
Copyright © 2025 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
Conflict of interest statement
Conflict of Interest Statement Dr Enzinger is a consultant for and received honoraria from Astellas Pharma, BeiGene USA, Daiichi Sankyo, Eisai, Legend Biotech, Merck & Co, Novartis, Oncolys BioPharma, Regeneron, Sanofi-Aventis, and Servier Pharmaceuticals. Dr Kleinberg received grants or contracts, consulting fees, and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novocure (institution), Novartis (institution), BMS (institution), Incyte (institution), Accuray (personal), and Servier (personal). Dr Maron received honoraria from Novartis, Amgen, Elevation Oncology, Pinetree Therapeutics, Purple Oncology, Bolt Therapeutics, and Daiichi Sankyo; has a financial interest in OneCellDx; and received research funding from Conquer Cancer Foundation, research travel support from AstraZeneca, and research support from AstraZeneca and Paige.AI. Dr Molena received consulting fees, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events, support for attending meetings and/or travel, participation on a Data Safety Monitoring Board or Advisory Board: AstraZeneca, J&J, Boston Scientific, Boehringer, BMS, Ideology health, and Merck. Dr Murthy reports consultant for OnTarget, Lazzaro Medical, Inc, and Arthrex; and speaker for Medtronic and Intuitive Surgical Inc. Dr Palta reports research funding to institution from Merck and Varian Medical Systems; royalties from UpToDate; advisory board of Varian Medical Systems; board of ASCO GI meeting Committee; ASTRO Education and CME Committee. Dr Pouw reports consultancy fee from icroTech Europe, consultancy for Medtronic B.V. (payment to institution); speaker fees from Pentax B.V. and Boston Scientific; and research grant from Möller Medical (payment to institution). Dr Reddy reports grants or contracts, consulting fees, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events, participation on a Data Safety Monitoring Board or Advisory Board, and leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid: Intuitive, AtriCure, Genentech, On Target Labs, Medtronic, Bristol Myers Squib, General thoracic surgical club, and MIXR Center. Dr Schumacher reports consulting fees from Intuitive Surgical and Medtronic. Dr Sihag reports consulting fees and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Astra Zeneca, Intuitive Surgical, and Medtronic. Dr Worrell consulting fees and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Intuitive and Genentech. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.
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