{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T18:32:45Z","timestamp":1763058765648,"version":"3.41.2"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2022,7,20]],"date-time":"2022-07-20T00:00:00Z","timestamp":1658275200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,12,31]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:p>Background: There is currently a lack of evidence-based guidelines regarding surveillance for recurrence after esophageal and gastric (OG) cancer surgical resection, and which symptoms should prompt endoscopic or radiological investigations for recurrence. The aim of this study was to develop a core symptom set using a modified Delphi consensus process that should guide clinicians to carry out investigations to look for suspected recurrent OG cancer in previously asymptomatic patients. Methods: A web-based survey of 42 questions was sent to surgeons performing OG cancer resections at high volume centers. The first section evaluated the structure of follow-up and the second, determinants of follow-up. Two rounds of a modified Delphi consensus process and a further consensus workshop were used to determine symptoms warranting further investigations. Symptoms with a 75% consensus agreement as suggestive of recurrent cancer were included in the core symptom set. Results: 27 surgeons completed the questionnaires. A total of 70.3% of centers reported standardized surveillance protocols, whereas 3.7% of surgeons did not undertake any surveillance in asymptomatic patients after OG cancer resection. In asymptomatic patients, 40.1% and 25.9% of centers performed routine imaging and endoscopy, respectively. The core set that reached consensus, consisted of eight symptoms that warranted further investigations included; dysphagia to solid food, dysphagia to liquids, vomiting, abdominal pain, chest pain, regurgitation of foods, unexpected weight loss and progressive hoarseness of voice. Conclusion: There is global variation in monitoring patients after OG cancer resection. Eight symptoms were identified by the consensus process as important in prompting radiological or endoscopic investigation for suspected recurrent malignancy. Further randomized controlled trials are necessary to link surveillance strategies to survival outcomes and evaluate prognostic value.<\/jats:p>","DOI":"10.1093\/dote\/doac038","type":"journal-article","created":{"date-parts":[[2022,7,20]],"date-time":"2022-07-20T20:09:07Z","timestamp":1658347747000},"source":"Crossref","is-referenced-by-count":2,"title":["Identifying a core symptom set triggering radiological and endoscopic investigations for suspected recurrent esophago-gastric cancer: a modified Delphi consensus process"],"prefix":"10.1093","volume":"36","author":[{"given":"Swathikan","family":"Chidambaram","sequence":"first","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London , London , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5623-2404","authenticated-orcid":false,"given":"Nikhil M","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London , London , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viknesh","family":"Sounderajah","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London , London , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4993-2197","authenticated-orcid":false,"given":"Rita","family":"Alfieri","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Veneto Institute of Oncology-IRCCS , Padova , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4880-1670","authenticated-orcid":false,"given":"Luigi","family":"Bonavina","sequence":"additional","affiliation":[{"name":"Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS Padua , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward","family":"Cheong","sequence":"additional","affiliation":[{"name":"Department of Upper Gastrointestinal Surgery, Norfolk and Norwich University Hospital , Norwich , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andy","family":"Cockbain","sequence":"additional","affiliation":[{"name":"Department of Upper Gastrointestinal Surgery, Leeds Teaching Hospitals NHS Trust , Leeds , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xavier Benoit","family":"D\u2019Journo","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Aix-Marseille University, North Hospital , Marseille , France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenzo","family":"Ferri","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery and Upper Gastrointestinal Surgery, McGill University , Montr\u00e9al , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6630-3547","authenticated-orcid":false,"given":"Ewen A","family":"Griffiths","sequence":"additional","affiliation":[{"name":"Department of Upper Gastrointestinal Surgery , Queen Elizabeth Hospital, , Birmingham , UK"},{"name":"University Hospitals Birmingham NHS Trust , Queen Elizabeth Hospital, , Birmingham , UK"},{"name":"Institute of Cancer and Genomic Sciences , College of Medical and Dental Sciences, , Birmingham , UK"},{"name":"University of Birmingham , College of Medical and Dental Sciences, , Birmingham , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1859-9213","authenticated-orcid":false,"given":"Peter","family":"Grimminger","sequence":"additional","affiliation":[{"name":"Department of General Surgery, University of Mainz , Mainz , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline","family":"Gronnier","sequence":"additional","affiliation":[{"name":"Digestive Surgery, CHU of Bordeaux , Bordeaux , France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Gutschow","sequence":"additional","affiliation":[{"name":"Department of Surgery and Transplantation, University Hospital Zurich , Zurich , Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1308-4592","authenticated-orcid":false,"given":"Jakob","family":"Hedberg","sequence":"additional","affiliation":[{"name":"Section of Gastrointestinal Surgery , Department of Surgical Sciences, , Uppsala , Sweden"},{"name":"Uppsala University , Department of Surgical Sciences, , Uppsala , Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joonas H","family":"Kauppila","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm , Sweden"},{"name":"Department of Surgery , Oulu University Hospital, , Oulo , Finland"},{"name":"University of Oulu , Oulu University Hospital, , Oulo , Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sjoerd","family":"Lagarde","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus University Medical Center , Rotterdam , the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donald","family":"Low","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center , Seattle, WA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe","family":"Nafteux","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Katholieke Universiteit Leuven , Leuven , Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grard","family":"Nieuwenhuijzen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Catharina Hospital , Eindhoven , the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magnus","family":"Nilsson","sequence":"additional","affiliation":[{"name":"Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet , Stockholm , Sweden"},{"name":"Department of Upper Abdominal Diseases, Karolinska University Hospital , Stockholm , Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Rosati","sequence":"additional","affiliation":[{"name":"Department of Surgery, San Raffaele Hospital , Milan , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wolfgang","family":"Schroeder","sequence":"additional","affiliation":[{"name":"Department of General , Visceral, Cancer and Transplantation Surgery, , Cologne , Germany"},{"name":"University of Cologne , Visceral, Cancer and Transplantation Surgery, , Cologne , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B Mark","family":"Smithers","sequence":"additional","affiliation":[{"name":"Upper GI and Soft Tissue Unit , Academy of Surgery, Princess Alexandra Hospital, Faculty of Medicine, , Brisbane , Australia"},{"name":"University of Queensland , Academy of Surgery, Princess Alexandra Hospital, Faculty of Medicine, , Brisbane , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark I","family":"van Berge Henegouwen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam University Medical Centers , Amsterdam , the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"van Hillegesberg","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Center Utrecht , Utrecht , the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7683-2693","authenticated-orcid":false,"given":"David I","family":"Watson","sequence":"additional","affiliation":[{"name":"Discipline of Surgery , College of Medicine and Public Health, , Adelaide , Australia"},{"name":"Flinders University , College of Medicine and Public Health, , Adelaide , Australia"},{"name":"Department of Surgery, Flinders Medical Center , Adelaide , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ravinder","family":"Vohra","sequence":"additional","affiliation":[{"name":"Department of Esophagogastric Surgery, Nottingham University Hospitals NHS Trust , Nottingham , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nick","family":"Maynard","sequence":"additional","affiliation":[{"name":"Department of Upper GI Surgery, Oxford University Hospitals NHS Foundation Trust , Oxford , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheraz R","family":"Markar","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London , London , UK"},{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm , Sweden"},{"name":"Department of Upper GI Surgery, Oxford University Hospitals NHS Foundation Trust , Oxford , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,7,21]]},"reference":[{"issue":"1","key":"2023010614045675800_ref1","doi-asserted-by":"crossref","first-page":"17048","DOI":"10.1038\/nrdp.2017.48","article-title":"Oesophageal cancer","volume":"3","author":"Smyth","year":"2017","journal-title":"Nat Rev Dis Prim [internet]"},{"issue":"12","key":"2023010614045675800_ref2","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1097\/01.JTO.0000437420.38972.fb","article-title":"Esophageal cancer recurrence patterns and implications for surveillance","volume":"8","author":"Lou","year":"2013","journal-title":"J Thorac Oncol"},{"key":"2023010614045675800_ref3","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1186\/s13019-020-01202-2","article-title":"The treatments and postoperative complications of esophageal cancer: a review","volume":"15","author":"Xu","year":"2020","journal-title":"J Cardiothorac Surg"},{"key":"2023010614045675800_ref4","article-title":"Oesophago-gastric cancer: assessment and management in adults","volume":"4","author":"NICE","year":"2018","journal-title":"NICE Guidel"},{"key":"2023010614045675800_ref5","doi-asserted-by":"crossref","DOI":"10.1186\/1477-7819-8-75","article-title":"Proposed follow up programme after curative resection for lower third oesophageal cancer","volume":"8","author":"Moyes","year":"2010","journal-title":"World J Surg Oncol"},{"issue":"4","key":"2023010614045675800_ref6","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1016\/j.jamcollsurg.2010.01.006","article-title":"Recurrence after esophagectomy for adenocarcinoma: defining optimal follow-up intervals and testing","volume":"210","author":"Abate","year":"2010","journal-title":"J Am Coll Surg"},{"key":"2023010614045675800_ref7","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1038\/nrclinonc.2012.35","article-title":"Screening for oesophageal cancer","volume":"9","author":"Lao-Sirieix","year":"2012","journal-title":"Nat Rev Clin Oncol"},{"issue":"11","key":"2023010614045675800_ref8","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1016\/S1470-2045(19)30456-5","article-title":"Progress in cancer survival, mortality, and incidence in seven high-income countries 1995\u20132014 (ICBP SURVMARK-2): a population-based study","volume":"20","author":"Arnold","year":"2019","journal-title":"Lancet Oncol"},{"key":"2023010614045675800_ref9","article-title":"Evaluation of postoperative surveillance strategies for esophago-gastric cancers in the UK and Ireland","volume":"35","author":"Chidambaram","year":"2021","journal-title":"Dis Esophagus"},{"issue":"2","key":"2023010614045675800_ref10","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/s00268-016-3746-0","article-title":"Risk factors for anastomotic stricture post-esophagectomy with a standardized sutured anastomosis","volume":"41","author":"Ahmed","year":"2017","journal-title":"World J Surg"},{"key":"2023010614045675800_ref11","article-title":"Clinical utility and applicability of circulating tumor DNA testing in esophageal cancer: a systematic review and meta-analysis","volume":"35","author":"Chidambaram","year":"2021","journal-title":"Dis Esophagus"},{"issue":"13","key":"2023010614045675800_ref12","doi-asserted-by":"crossref","first-page":"1692","DOI":"10.1002\/bjs.9647","article-title":"Delphi survey to identify topics to be addressed at the initial follow-up consultation after oesophageal cancer surgery","volume":"101","author":"Jacobs","year":"2014","journal-title":"Br J Surg"},{"issue":"2","key":"2023010614045675800_ref13","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1053\/j.gastro.2012.04.032","article-title":"Consensus statements for management of Barrett\u2019s dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process","volume":"143","author":"Bennett","year":"2012","journal-title":"Gastroenterology"},{"journal-title":"Ann Surg [Internet]","article-title":"Lasting symptoms after esophageal resection (LASER): European Multicenter Cross-sectional Study","author":"Markar","key":"2023010614045675800_ref14"},{"issue":"4","key":"2023010614045675800_ref15","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.jclinepi.2013.12.002","article-title":"Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies","volume":"67","author":"Diamond","year":"2014","journal-title":"J Clin Epidemiol"},{"issue":"3","key":"2023010614045675800_ref16","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1159\/000338256","article-title":"Patient preferences in screening for recurrent disease after potentially curative esophagectomy","volume":"29","author":"Blom","year":"2012","journal-title":"Dig Surg"},{"key":"2023010614045675800_ref17","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1245\/s10434-015-4840-5","article-title":"Prognosis and treatment after diagnosis of recurrent esophageal carcinoma following esophagectomy with curative intent","volume":"22","author":"Parry","year":"2015","journal-title":"Ann Surg Oncol"},{"issue":"12","key":"2023010614045675800_ref18","doi-asserted-by":"crossref","first-page":"1702","DOI":"10.1001\/jamaoncol.2019.3105","article-title":"Association of early palliative care use with survival and place of death among patients with advanced lung cancer receiving care in the veterans health administration","volume":"5","author":"Sullivan","year":"2019","journal-title":"JAMA Oncologia"},{"issue":"12","key":"2023010614045675800_ref19","doi-asserted-by":"crossref","first-page":"1848","DOI":"10.1038\/s41416-020-0829-3","article-title":"The association between unexpected weight loss and cancer diagnosis in primary care: a matched cohort analysis of 65,000 presentations","volume":"122","author":"Nicholson","year":"2020","journal-title":"Br J Cancer"}],"container-title":["Diseases of the Esophagus"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/dote\/article-pdf\/36\/1\/doac038\/48468130\/doac038.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/dote\/article-pdf\/36\/1\/doac038\/48468130\/doac038.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T14:09:42Z","timestamp":1673014182000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/dote\/article\/doi\/10.1093\/dote\/doac038\/6647503"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,21]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,7,21]]},"published-print":{"date-parts":[[2022,12,31]]}},"URL":"https:\/\/doi.org\/10.1093\/dote\/doac038","relation":{},"ISSN":["1120-8694","1442-2050"],"issn-type":[{"type":"print","value":"1120-8694"},{"type":"electronic","value":"1442-2050"}],"subject":[],"published-other":{"date-parts":[[2023,1]]},"published":{"date-parts":[[2022,7,21]]},"article-number":"doac038"}}