Update of the national guideline on upper gastrointestinal cancer
Authors: Lerut T. , Stordeur Sabine , Verleye Leen , Vlayen Joan , Boterberg Tom , De Hertogh Gert , De Mey J. , Deprez Pierre , Flamen P. , Pattyn P. , Van Laethem Jean-Luc , Peeters Marc 
Published: January 2025

1. SEARCH STRATEGIES 5 -- 1.1. UPDATE SYSTEMATIC REVIEWS 5 -- 1.1.1. OVID Medline 5 -- 1.1.2. OVID PreMedline 5 -- 1.1.3. EMBASE 6 -- 1.1.4. Cochrane Library 6 -- 1.2. UPDATE RANDOMIZED CONTROLLED TRIALS 7 -- 1.2.1. OVID Medline 7 -- 1.2.2. OVID PreMedline 7 -- 1.2.3. EMBASE 9 -- 1.2.4. CENTRAL 9 -- 1.3. UPDATE DIAGNOSTIC STUDIES 9 -- 1.3.1. OVID Medline 9 -- 1.3.2. OVID PreMedline 12 -- 1.3.3. EMBASE 15 -- 2. EXTERNAL EXPERT REVIEW 16 -- 3. TNM-7 CLASSIFICATION 1 21 -- 3.1. OESOPHAGUS INCLUDING OESOPHAGOGASTRIC JUNCTION (ICD-O C15 AND C16.0) 21 -- 3.1.1. TNM clinical classification 21 -- 3.1.2. pTNM pathological classification 21 -- 3.1.3. Stage grouping 21 -- 3.1.4. Prognostic grouping 22 -- 3.2. STOMACH (ICD-O C16) 22 -- 3.2.1. Anatomical subsites 22 -- 3.2.2. TNM clinical classification 22 -- 3.2.3. pTNM pathological classification 23 -- 3.2.4. Stage grouping 23 -- 4. EVIDENCE TABLES: OESOPHAGEAL CANCER 24 -- 4.1. INITIAL STAGING 24 -- 4.1.1. Imaging techniques (EUS, CT, PET, PET/CT) and minimally invasive surgical procedures 24 -- 4.2. NEOADJUVANT TREATMENT 43 -- 4.2.1. Radiotherapy 43 -- 4.2.2. Neoadjuvant Chemotherapy vs. surgery alone 44 -- 4.2.3. Neoadjuvant chemotherapy vs. Adjuvant Chemotherapy 47 -- 4.2.4. Neoadjuvant Chemoradiotherapy vs. surgery alone 48 -- 4.2.5. Neoadjuvant chemotherapy vs neoadjuvant chemoradiotherapy 54 -- 4.2.6. Definitive chemoradiotherapy (dCRT) versus neoadjuvant treatment followed by surgery or surgery alone 55 -- 4.3. RESTAGING AFTER NEOADJUVANT TREATMENT 56 -- 4.3.1. Systematic reviews 56 -- 4.3.2. Primary studies 61 -- 4.4. TREATMENT OF MUCOSAL CANCER 64 -- 4.4.1. Systematic reviews 64 -- 4.5. SURGERY FOR CANCER BEYOND MUCOSA 66 -- 4.5.1. Esophageal transthoracic technique vs. oesophageal transhiatal technique 66 -- 4.5.2. Open oesophagectomy vs. minimally invasive surgery 70 -- 4.5.3. Anastomotic techniques 73 -- 4.5.4. Volume-outcomes relationship 76 -- 4.6. ADJUVANT TREATMENT 78 -- 4.6.1. Chemotherapy 78 -- 4.6.2. Radiotherapy 78 -- 4.6.3. Chemoradiotherapy 78 -- 4.7. NON-SURGICAL TREATMENT WITH CURATIVE INTENT 78 -- 4.7.1. Definitive chemoradiotherapy vs. Radiotherapy alone 78 -- 4.7.2. Definitive chemoradiotherapy 80 -- 4.8. TREATMENT OF METASTATIC DISEASE 81 -- 4.8.1. Chemotherapy 81 -- 4.8.2. Radiotherapy 83 -- 4.8.3. Other interventions (laser, thermotherapy, brachytherapy 84 -- 4.8.4. Stenting 86 -- 4.8.5. Radiotherapy 89 -- 4.9. FOLLOW-UP 91 -- 4.9.1. Primary studies: RCTs 91 -- 4.9.2. Primary studies: diagnostic accuracy studies 92 -- 5. EVIDENCE TABLES: GASTRIC CANCER 93 -- 5.1. STAGING 93 -- 5.1.1. Endoscopic Ultrasound (EUS) 93 -- 5.1.2. Conventional imaging 98 -- 5.1.3. Laparoscopic staging 115 -- 5.1.4. Sentinel node biopsy 117 -- 5.2. TREATMENT EARLY GASTRIC CANCER 120 -- 5.2.1. Endoscopic submucosal resection versus endoscopic mucosal dissection 120 -- 5.2.2. Endoscopic mucosal resection versus gastrectomy 121 -- 5.3. TREATMENT GASTRIC CANCER BEYOND MUCOSA: RESECTABLE GASTRIC CANCER 122 -- 5.3.1. Neoadjuvant treatment 122 -- 5.3.2. Surgery 124 -- 5.3.3. Adjuvant treatment 140 -- 5.4. TREATMENT GASTRIC CANCER BEYOND MUCOSA: ADVANCED (UN)RESECTABLE GASTRIC -- CANCER 152 -- 5.4.1. Surgery: gastrectomy +/- Multivisceral resection (MVR) 152 -- 5.4.2. IP chemotherapy 154 -- 5.4.3. Chemotherapy 156 -- 5.4.4. Surgery for gastric perforation 166 -- 5.4.5. Surgery or stenting for malignant gastric outlet obstruction 167 -- 5.5. TREATMENT OF RECURRENT DISEASE 170 -- 6. REFERENCES 171