Rishabh Jain, Medical Consultant at Renova Hospital (RHL), shared on LinkedIn:
“ESMO 2026: A new treatment algorithm for localized gastric and esophageal cancer!
- Esophageal SCC: CROSS – Surgery – Adjuvant nivolumab (if residual disease)
- Gastric/GEJ adenocarcinoma: Perioperative D-FLOT + durvalumab maintenance is now preferred.
- Early-stage disease: Endoscopic or surgical resection.
- Unresectable/unfit: Definitive chemoradiotherapy.
The key shift: Immunotherapy is now integrated into curative-intent treatment for selected patients.”
Moawia Mohammed Ali Elhassan, Consultant of Radiation Oncology at KKUMC, Associate Professor at University of Gezira, added:
“A well-written summary by Dr Rishabh Jain on ESMO2026 treatment algorithm for localized esophageal carcinoma and gastric carcinoma.”
More information on surgical aspect from this guideline:
- Surgery with curative intent is recommended for fit patients with locally advanced, resectable esophageal squamous cell carcinoma (OSCC). The preferred approach is transthoracic esophagectomy with lymph node dissection in both the chest and abdomen.
- Surgical approach depends on tumor location: the McKeown procedure is preferred for upper (supra-carinal) tumors, while the Ivor-Lewis procedure is used for lower (infra-carinal) tumors. Neck lymph node dissection is generally reserved for suspected or confirmed nodal involvement or cervical tumors.
- Robotic transthoracic surgery is associated with fewer overall and pulmonary complications and similar long-term cancer outcomes compared with open surgery. It may also allow more lymph nodes to be removed than conventional minimally invasive surgery during the McKeown procedure.
- For Ivor-Lewis surgery, a hybrid approach (laparoscopy plus open chest surgery) is generally favoured over fully open surgery. Fully minimally invasive or robotic approaches may increase the risk of anastomotic leaks and should be considered mainly by experienced surgeons or in clinical trials.
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