Davies AR et al. (2006) The multidisciplinary team meeting improves staging accuracy and treatment selection for gastro-esophageal cancer. Dis Esophagus 19: 496–503

Accurate cancer staging is vital if patients are to be given realistic prognostic information and offered appropriate therapy. Davies and colleagues, therefore, compared the accuracy of individual staging modalities for esophagogastric cancer (CT, endoscopic and laparoscopic ultrasonography) with that of a multidisciplinary team approach—in which a specialist team of esophagogastric surgeons, gastroenterologists, medical and radiation oncologists and other staff discussed all the available staging data and arrived at a consensus tumor stage, before selection of definitive treatment.

The authors evaluated 118 patients (median age 65 years, 92 men) with histologically proven, potentially resectable carcinoma of the stomach or esophagus. The tumor-node-metastasis stage for each patient was recorded after CT, endoscopic ultrasonography (in patients without metastasis) and laparoscopic ultrasonography (in those with tumors below the diaphragm). In total, 13 patients underwent chemotherapy then surgery, and 105 underwent surgery only. At surgery, 104 patients underwent resection and 14 underwent noncurative procedures. When preoperative staging assessments were compared with those obtained histopathologically, the multidisciplinary team approach performed better than any individual imaging modality: 88–89% of cancers were staged correctly. Only two patients were undertreated (both should have received preoperative chemotherapy, but did not).

Davies and colleagues say that their results demonstrate the value of a team approach, in which the results of multiple investigations are discussed. A multidisciplinary approach to cancer staging ensures that correct management decisions are made for the greatest possible number of patients.