title: International comparison of the German evidence-based S3-guidelines on the diagnosis and multimodal treatment of early and locally advanced gastric cancer, including adenocarcinoma of the lower esophagus.
abstract: BACKGROUND
  Clinical guidelines are essential in implementing and maintaining nationwide stage-specific diagnostic and therapeutic standards. In 2011, the first German expert consensus guideline defined the evidence for diagnosis and treatment of early and locally advanced esophagogastric cancers. Here, we compare this guideline with other national guidelines as well as current literature.
  
  
  METHODS
  The German S3-guideline used an approved development process with de novo literature research, international guideline adaptation, or good clinical practice. Other recent evidence-based national guidelines and current references were compared with German recommendations.
  
  
  RESULTS
  In the German S3 and other Western guidelines, adenocarcinomas of the esophagogastric junction (AEG) are classified according to formerly defined AEG I-III subgroups due to the high surgical impact. To stage local disease, computed tomography of the chest and abdomen and endosonography are reinforced. In contrast, laparoscopy is optional for staging. Mucosal cancers (T1a) should be endoscopically resected "en-bloc" to allow complete histological evaluation of lateral and basal margins. For locally advanced cancers of the stomach or esophagogastric junction (≥T3N+), preferred treatment is preoperative and postoperative chemotherapy. Preoperative radiochemotherapy is an evidence-based alternative for large AEG type I-II tumors (≥T3N+). Additionally, some experts recommend treating T2 tumors with a similar approach, mainly because pretherapeutic staging is often considered to be unreliable.
  
  
  CONCLUSIONS
  The German S3 guideline represents an up-to-date European position with regard to diagnosis, staging, and treatment recommendations for patients with locally advanced esophagogastric cancer. Effects of perioperative chemotherapy versus chemoradiotherapy are still to be investigated for adenocarcinoma of the cardia and the lower esophagus.
authors.affiliation: University Medical Center Mainz, Mainz, Germany, markus.moehler@unimedizin-mainz.de.
authors.forename: Markus
authors.initials: M
authors.lastname: Moehler
authors.forename: Christoph T H
authors.initials: CT
authors.lastname: Baltin
authors.forename: Matthias
authors.initials: M
authors.lastname: Ebert
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Fischbach
authors.forename: Ines
authors.initials: I
authors.lastname: Gockel
authors.forename: Lars
authors.initials: L
authors.lastname: Grenacher
authors.forename: Arnulf H
authors.initials: AH
authors.lastname: Hölscher
authors.forename: Florian
authors.initials: F
authors.lastname: Lordick
authors.forename: Peter
authors.initials: P
authors.lastname: Malfertheiner
authors.forename: Helmut
authors.initials: H
authors.lastname: Messmann
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Meyer
authors.forename: Anne
authors.initials: A
authors.lastname: Palmqvist
authors.forename: Christoph
authors.initials: C
authors.lastname: Röcken
authors.forename: Christoph
authors.initials: C
authors.lastname: Schuhmacher
authors.forename: Michael
authors.initials: M
authors.lastname: Stahl
authors.forename: Martin
authors.initials: M
authors.lastname: Stuschke
authors.forename: Michael
authors.initials: M
authors.lastname: Vieth
authors.forename: Christian
authors.initials: C
authors.lastname: Wittekind
authors.forename: Dorothea
authors.initials: D
authors.lastname: Wagner
authors.forename: Stefan P
authors.initials: SP
authors.lastname: Mönig
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods; D003131:Combined Modality Therapy; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D004943:Esophagogastric Junction / Q000473:pathology; D006801:Humans; D010535:Laparoscopy; D020360:Neoadjuvant Therapy; D019990:Perioperative Care; D017410:Practice Guidelines as Topic; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*