title: The multidisciplinary team meeting improves staging accuracy and treatment selection for gastro-esophageal cancer.
abstract: The object of this article is to assess current staging accuracies for individual modalities and to investigate the influence of the multidisciplinary team (MDT) on clinical staging accuracies and treatment selection for patients with gastro-esophageal cancer. Patients newly diagnosed with gastric or esophageal cancer and who were deemed suitable for surgical resection by the MDT were studied. Patients were staged with a combination of computerized tomography (CT), endoscopic ultrasound (EUS) and laparoscopic ultrasound (LUS). Additionally, the MDT determined an overall clinical stage for each patient after discussion at the MDT meeting. Treatments were selected according to this final clinical stage. Final histopathological staging (pTNM) was available for all patients and was used as the gold standard for determining staging accuracy. Suitability of treatment selection was assessed once final pTNM was available. One hundred and eighteen patients were studied. Endoscopic ultrasound was the most accurate individual staging modality for the loco-regional assessment of esophageal tumors (T stage accuracy 78%, N stage accuracy 70%). Laparoscopic ultrasound was the most accurate modality in T staging of gastric cancers (91%). The MDT stage was more accurate than each individual staging modality for T and N staging for both gastric and esophageal cancers (accuracy range: 88-89%) and was better for the assessment of nodal disease than each individual modality (CT P < 0.001, EUS P < 0.01, LUS P < 0.01). Overall staging accuracy as determined at the MDT meeting was increased and resulted in only 2/118 (2%) patients being under-treated. The MDT significantly improves staging accuracy for gastro-esophageal cancer and ensures that correct management decisions are made for the highest number of individual patients.
authors.affiliation: Department of Surgery, Lothian Oesophago-Gastric Cancer Group, Royal Infirmary, Edinburgh, UK.
authors.forename: A R
authors.initials: AR
authors.lastname: Davies
authors.forename: D A C
authors.initials: DA
authors.lastname: Deans
authors.forename: I
authors.initials: I
authors.lastname: Penman
authors.forename: J N
authors.initials: JN
authors.lastname: Plevris
authors.forename: J
authors.initials: J
authors.lastname: Fletcher
authors.forename: L
authors.initials: L
authors.lastname: Wall
authors.forename: H
authors.initials: H
authors.lastname: Phillips
authors.forename: H
authors.initials: H
authors.lastname: Gilmour
authors.forename: D
authors.initials: D
authors.lastname: Patel
authors.forename: A
authors.initials: A
authors.lastname: de Beaux
authors.forename: S
authors.initials: S
authors.lastname: Paterson-Brown
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000628:therapy*; D000368:Aged; D000465:Algorithms; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010348:Patient Care Team; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D014057:Tomography, X-Ray Computed