PhD defence B.J. (Berend) van der Wilk

Dissertation in short:

Esophageal cancer remains a disease with a poor prognosis. Improvement of overall survival was reached mostly after the introduction of additional therapies prior to surgery or perioperatively. Since nearly one-third of patients with esophageal cancer have a pathologically complete response (i.e. no vital tumor cells in the resection specimen), the benefit of standard esophagectomy for every patient after chemoradiotherapy has been topic of debate. The SANO-trial compares an active surveillance strategy with standard esophagectomy for patients with a clinically complete response after neoadjuvant chemoradiotherapy. A clinically complete response is identified in those patients in whom no tumor cells can be detected with clinical response evaluations, consisting of PET-CT, endoscopic bite-on-bite biopsies and endoscopic ultrasound. As of December 2020, the inclusion phase of the SANO-trial has been completed. The short-term analysis of overall survival will be performed after a minimum follow-up of two years. This thesis consists of three parts; studies aimed 
at improving clinical response evaluations are described in Part I, studies comparing open with hybrid and totally minimally invasive esophagectomy are described in Part II and studies aimed at improving shared decision making for active surveillance and studies describing current knowledge on overall survival after active surveillance are described in Part III.