Background: Oesophago-gastric cancer surgery negatively affects quality of life with a high postoperative symptom burden. Several conditions that may be diagnosed and treated after surgery are recognised. However, consensus regarding their definition and management is lacking. This study aimed to develop consensus regarding the definition, investigation and management of the common symptoms and conditions, and triggers to consider disease recurrence, as a foundation for improving management and quality of life in these patients.
Method: Modified two-round Delphi consensus study of a multidisciplinary expert panel.
Results: Eighty-six of 127 (67.7%) and 77 of 93 (82.8%) responses were received in rounds 1 and 2. Consensus was achieved in defining 26 symptoms. For 10 conditions (anastomotic stricture, acid reflux, non-acid reflux, biliary gastritis, delayed gastric emptying, dumping syndrome, exocrine pancreatic insufficiency, bile acid diarrhoea, small intestinal bacterial overgrowth and carbohydrate malabsorption), definitions, diagnostic criteria, first- and second-line investigation and first-line treatments were agreed. Consensus was not reached for third-line investigation of some conditions, or for second-, third- or fourth-line treatments for others. Twelve of 14 (85.7%) symptoms were agreed as triggers to consider cancer recurrence, during the early (<1 year) and late (>1 year) postoperative periods.
Conclusion: Expert consensus regarding symptoms, conditions and triggers to consider investigation for recurrence after oesophago-gastric cancer surgery was achieved. This may allow standardization and timely diagnosis and treatment of postoperative conditions, reducing variation in care and optimizing patients' quality of life.
Background: Surgery to remove cancer from the gullet (food pipe) and stomach can cause a range of different symptoms, like difficulty swallowing food, pain in the tummy, feeling sick or diarrhoea. These symptoms happen because of a number of different problems like the new stomach tube not pushing food through properly, changes in normal digestion, or changes in the bacteria inside the gut. It can be difficult to work out the cause of different symptoms because there is no agreement about how to diagnose and treat these different types of problem. Some of the symptoms can be caused by the cancer coming back.
Aim: This project aimed to get experts together to agree how to describe different symptoms and how to treat different problems after surgery, as well as what symptoms might suggest the cancer has come back.
Method: A group of experts who already help patients with these symptoms was created. These experts were asked a series of questions using an online survey (round 1). The study team then looked at the answers and made some changes. The experts were then asked to answer the new online survey (round 2) and the results were collected to see where there was good agreement from the experts taking part in the project.
Findings and conclusion: Experts agreed on 26 different symptoms that affect patients who have had surgery for cancer of the gullet or stomach. They also agreed how to look for 10 different problems that can affect patients and how to treat them. In addition, they agreed on several symptoms that should make doctors look for whether the cancer has come back.This new agreement will help doctors to treat symptoms and problems in patients who have had surgery for cancer of the gullet or stomach. This could help patients have a better quality of life. It will also help other researchers who are trying to help these patients by making it clear that they are looking at the same type of problem. It has also shown that more research is needed in certain areas to help these patients.
© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].