PD07.07. Impact of the ESOPEC Trial on Perioperative Management of Resectable Esophageal Adenocarcinoma: A Global Practice Survey

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ID: 326177
2026
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Abstract
Abstract Topic Esophageal Cancer: Adjuvant and Neo-Adjuvant Therapies Background The phase III ESOPEC trial showed improved survival with perioperative FLOT compared with CROSS chemoradiation in resectable esophageal adenocarcinoma, challenging established practice. Although both remain guideline-supported, it is unclear how ESOPEC has influenced real-world care. We surveyed clinicians to evaluate FLOT adoption, current treatment patterns, and barriers to implementation. Methods An anonymous, cross-sectional Qualtrics survey was distributed through professional surgical networks targeting thoracic surgeons and medical oncologists. Respondents were queried on perioperative treatment preferences, changes post-ESOPEC, perceived outcomes, and barriers to FLOT use. Responses were summarized descriptively and stratified by practice setting, case volume, and region. Results Among 59 respondents, 98.3% were thoracic surgeons and 36.4% had >15 years in practice. Most worked at academic centers (82.1%). 56.4% performed 10–24 esophagectomies in 2024, and 71.4% participated in weekly tumor boards. Familiarity with ESOPEC was high(87.5%), and 75% found the results somewhat compelling or practice changing. FLOT was preferred for fit patients with adenocarcinoma(80.4%), while CROSS remained favored for squamous histology(86.3%). Since ESOPEC, 96.1% reported increased FLOT use, including 58.8% reporting a >50% rise. Regimens were individualized based on performance status(96.1%), histology(66.7%), age >75(64.7%), and tumor location(47.1%). Surgeons reported worse delivery of adjuvant chemotherapy(59.2%) and quality of life(50%) with FLOT, but no differences in leak rate or other perioperative outcomes.Toxicity(87.8%) and chemotherapy completion(59.2%) were concerns. Only 48.2% reported institutional guideline updates, though many reported long-term survival data(62.5%) would support full transition to FLOT. Conclusion ESOPEC has increased FLOT use for adenocarcinoma, but CROSS remains preferred for squamous histology and select patients. Toxicity concerns, feasibility issues, and limited institutional adoption suggest further real-world data and guideline updates are needed to close the gap between evidence and practice.
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Authors Evelyn Alexander, Jeffrey Velotta, Ahmed Elkamel, Mazin Abdalgadir, Shamele Battan-Wraith, Hope Conrad, Richa Asija, Jonathan Rice, Praveen Sridhar, Stephanie Worrell
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.129
URL
https://academic.oup.com/dote/article-pdf/39/Supplement_1/doag077.129/70761162/doag077.129.pdf
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