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Vol. 63. Issue 5.
Pages 445-455 (September - October 2021)
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Vol. 63. Issue 5.
Pages 445-455 (September - October 2021)
Article from a resident
An updated review of the TNM classification system for cancer of the oesophagus and its complications
Cáncer de esófago: revisión actualizada del TNM y de sus complicaciones
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P. López Salaa,
Corresponding author
paullopezsala@gmail.com

Corresponding author.
, N. Alberdi Aldasoroa, I. Fuertes Fernándezb, J. Sáenz Bañuelosb
a Residente del Servicio de Radiodiagnóstico, Complejo Hospitalario de Navarra, Pamplona, Spain
b FEA del Servicio de Radiodiagnóstico, Complejo Hospitalario de Navarra, Pamplona, Spain
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Tables (4)
Table 1. Anatomical relationships of the compartments of the oesophagus.
Table 2. 8th edition of the TNM of the American Joint Committee on Cancer for squamous-cell carcinoma and adenocarcinoma of the oesophagus.
Table 3. Multidetector computed tomography findings suggestive of cT4 local invasion.
Table 4. Post-oesophagectomy complications.
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Abstract

Cancer of the esophagus is an aggressive cancer with high mortality. Because of the esophagus’s lack of serosa and its peculiar lymphatic drainage, esophageal cancer is diagnosed in advanced stages. The eighth edition of the TNM (2017) aims to standardize care for esophageal cancer throughout the world; it includes not only patients treated with esophagectomy alone, but also those receiving neoadjuvant chemotherapy and/or radiotherapy. One new development in the eighth edition is that it establishes separate classifications for different time periods, with pathologic stage groups for prior to treatment (cTNM), after esophagectomy (pTNM), and after neoadjuvant therapy (ypTNM). The combined use of endoscopic ultrasound, CT, PET-CT, and MRI provides the greatest accuracy in determining the clinical stage, and these techniques are essential for planning treatment and for evaluating the response to neoadjuvant treatment. Esophagectomy continues to be the main treatment; it is also the elective gastrointestinal surgery that has the highest mortality, and it carries the risk of multiple complications, including anastomotic leaks, pulmonary complications, technical complications, and functional complications

Keywords:
Esophageal cancer
Clinical staging
TNM
Postoperative complications
Resumen

El cáncer esofágico tiene un comportamiento agresivo con alta mortalidad. La ausencia de serosa y su peculiar drenaje linfático hacen que se diagnostique en estadios avanzados. La 8.ª edición TNM (2017) armoniza la atención del cáncer esofágico en todo el mundo e incluye no solo pacientes tratados con esofagectomía aislada, sino aquellos que han recibido tratamiento neoadyuvante con quimioterapia y/o radioterapia. Como novedad establece clasificaciones separadas y relacionadas temporalmente con el cáncer: un estadio clínico previo al tratamiento (cTNM), patológico tras esofagectomía (pTNM) y patológico posneoadyuvante (ypTNM). La combinación de la ecoendoscopia, tomografía computarizada (TC), tomografía por emisión de positrones asociada a TC y resonancia magnética proporciona la mayor precisión posible en la determinación del estadio clínico, y son esenciales para la planificación del tratamiento y evaluación posneoadyuvancia. El tratamiento principal sigue siendo la esofagectomía, que es la cirugía gastrointestinal electiva con mayor mortalidad y acarrea múltiples complicaciones: fugas anastomóticas, complicaciones pulmonares, técnicas y funcionales.

Palabras clave:
Cáncer de esófago
Estadio clínico
TNM
Complicaciones posquirúrgicas

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