Medical Oncology or Surgical Oncology: Which Branch Should Be Started in Esophageal Cancer Diagnostic Evaluation?

Objective We evaluated the effect of the branch of the cancer specialist (medical oncologist versus surgical oncologist) who initially examines a patient on treatment delay. The objective was to evaluate whether surgical oncology and medical oncology clinics, which have different operating styles, impact the timeliness of treatment. Additionally, we investigated the prognostic impact of the clinical and treatment-related factors in patients with esophageal cancer treated at our center. Methods This was a retrospective single-center study. The prognostic impact of resection type (R0 or R1-2), multimodal treatment, lymphovascular invasion (LVI), perineural invasion (PNI), lymph node metastases, cachexia at the time of diagnosis, smoking, and diagnostic application of endoscopic ultrasound was evaluated. Patients were stratified according to whether the orientation and management processes were based on a multimodal approach and whether they were first examined by a surgical oncologist or a medical oncologist for diagnostic workup and management. The impact of the management approach on progression-free survival (PFS) was evaluated. Results Use of a multimodal approach in patients with esophageal cancer was associated with longer PFS (26.7 vs 13.9 months, p = 0.002). LVI and cachexia were associated with shorter PFS (16.1 vs 29.4 months, p = 0.044 and 14.6 vs 29.0, p = 0.019, respectively). The first appointment of the patients in the medical oncology department was associated with shorter treatment delay (54 [IQR: 36-71] vs 31 [IQR: 24-48] days, p < 0.001). Conclusions Our findings suggest that the first appointment of patients in the medical oncology department may lead to a more systematic workup and treatment progress. We believe that systematic use of multimodal approaches for esophageal cancer may confer prognostic benefits.