Richard van Hillegersberg, surgeon, UMCU, Utrecht, The Netherlands
Biography
Education Background
Richard van Hillegersberg attended medical school in Rotterdam, the Netherlands. In 1993 he received his PhD with honor at the Department of Surgery, Erasmus MC in Rotterdam. From 1994-2000, he was trained in General Surgery in Rotterdam. From 2001-2002 he was fellow of Surgical Oncology in the Academic Medical Center and Antoni van Leeuwenhoek Netherlands Cancer Center Amsterdam.
Professional Career
Since 2003 he is appointed as staff surgeon at the University Medical Center Utrecht. From 2009 he is a full professor of gastrointestinal oncology.
Research/Study Field
• Research is focused on Upper GI minimally invasive and robotic surgery, surgical imaging and genetic profiling. He has authored over 15 chapters in textbooks concerning robotic forgut surgery and over 500 articles in international peer-reviewed journals. From 2018 he is chairman of the Educational committee of the European Society for Diseases for the Esophagus (ESDE) and member of the education committee of ISDE, he is associate editor of Diseases of the Esophagus and Digestive Surgery, founder and chairman of the Upper GI International Robotic Association (UGIRA).
Summary of presentation
Introduction: We aim to provide a clinical practice guideline on the definition, diagnosis, and treatment of esophagogastric oligometastatic disease (OMD), following the results of the OligoMetastatic Esophagogastric Cancer (OMEC) project.
Methods: This guideline was developed according to AGREE II guidelines for clinical practice guidelines. OMEC developed a multidisciplinary European consensus statement for the definition, diagnosis, and treatment of esophagogastric OMD using 3 subprojects including a systematic review, clinical case discussions, and a Delphi consensus study. OMEC identified patients for whom OMD should be considered (as categorized by consensus in Delphi rounds) and patients for whom OMD could be considered (as categorized by fair agreement in Delphi rounds). The OMEC consortium consists of 69 esophagogastric cancer experts, located in 50 expert cancer centers from 17 countries across Europe. These recommendations were not stratified for the histology of the primary tumor (adenocarcinoma or squamous cell carcinoma). The disease-free interval (DFI) was defined as the time interval between completion of primary tumor treatment and OMD.
Results: OMD should be considered in esophagogastric cancer patients with 1 organ affected by ≤3 metastases or 1 involved extra-regional lymph node station. In addition OMD should remain to be considered in patients with OMD without progression after systemic therapy. 18F-FDG PET/CT imaging is recommended for baseline staging and for restaging after systemic therapy when local treatment is considered, to exclude polymetastatic disease. For patients with synchronous or metachronous OMD with DFI ≤2 years, systemic therapy followed by restaging to consider local treatment should be considered as treatment whereas for patients with metachronous OMD with DFI >2 years upfront local treatment could also be considered as treatment.
Discussion: This is the first multidisciplinary European clinical practice guideline for the definition, diagnosis and treatment of esophagogastric OMD. The guideline can be used to standardize inclusion criteria in future clinical trials and could be a crucial step to address the significant variation in treatment approaches for esophagogastric OMD in the West.