title: Diagnostic evaluation, surgical technique, and perioperative management after esophagectomy: consensus statement of the German Advanced Surgical Treatment Study Group.
abstract: OBJECTIVE
  Correct diagnosis, surgical treatment, and perioperative management of patients with esophageal carcinoma remain crucial for prognosis within multimodal treatment procedures. This study aims to achieve a consensus regarding current management strategies in esophageal cancer by questioning a panel of experts from the German Advanced Surgical Treatment Study (GAST) group, comprised of 9 centers specialized in esophageal surgery, with a combined total of >220 esophagectomies per year.
  
  
  METHODS
  The Delphi method, a systematic and interactive, evidence-based approach, was used to obtain consensus statements from the GAST group regarding ambiguities and disparities in diagnosis, patient selection, surgical technique, and perioperative management of patients with esophageal carcinoma. After four rounds of surveys, agreement was measured by Likert scales and defined as full (100% agreement), near (≥66.6% agreement), or no consensus (<66.6% agreement).
  
  
  RESULTS
  Full or near consensus was obtained for essential aspects of esophageal cancer staging, proper surgical technique, perioperative management and indication for primary surgery, and neoadjuvant treatment or palliative treatment. No consensus was achieved regarding acceptability of minimally invasive technique and postoperative nutrition after esophagectomy.
  
  
  CONCLUSIONS
  The GAST consensus statement represents a position paper for treatment of patients with esophageal carcinoma which both contributes to the development of clinical treatment guidelines and outlines topics in need of further clinical studies.
authors.affiliation: Department of General and Visceral Surgery, University of Münster, Waldeyerstrasse 1, 48149 Münster, Germany. palmes@uni-muenster.de
authors.forename: Daniel
authors.initials: D
authors.lastname: Palmes
authors.forename: Matthias
authors.initials: M
authors.lastname: Brüwer
authors.forename: Franz G
authors.initials: FG
authors.lastname: Bader
authors.forename: Michael
authors.initials: M
authors.lastname: Betzler
authors.forename: Heinz
authors.initials: H
authors.lastname: Becker
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Bruch
authors.forename: Markus
authors.initials: M
authors.lastname: Büchler
authors.forename: Heinz
authors.initials: H
authors.lastname: Buhr
authors.forename: Beta Michael
authors.initials: BM
authors.lastname: Ghadimi
authors.forename: Ulrich T
authors.initials: UT
authors.lastname: Hopt
authors.forename: Ralf
authors.initials: R
authors.lastname: Konopke
authors.forename: Katja
authors.initials: K
authors.lastname: Ott
authors.forename: Stefan
authors.initials: S
authors.lastname: Post
authors.forename: Jörg-Peter
authors.initials: JP
authors.lastname: Ritz
authors.forename: Ulrich
authors.initials: U
authors.lastname: Ronellenfitsch
authors.forename: Hans-Detlev
authors.initials: HD
authors.lastname: Saeger
authors.forename: Norbert
authors.initials: N
authors.lastname: Senninger
mesh_terms: D003697:Delphi Technique; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005858:Germany; D006801:Humans; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010166:Palliative Care; D018579:Patient Selection; D059035:Perioperative Period; D011379:Prognosis