Surgical resection offers the best long-term survival chance in patients with locally advanced oesophageal or gastric cancer.

Palliative oesophageal resection for metastatic cancer is not recommended.

Timeframe for starting treatment

Treatment should begin within two weeks of the MDM. Surgery should be scheduled when appropriate to the overall treatment plan.

Training and experience required of the appropriate specialists

Surgeon (Fellow of the Royal Australasian College of Surgeons [FRACS] or equivalent) with additional training and experience in oesophagogastric surgery, and with institutional credentialing and agreed scope of practice within this area.

Documented evidence of the surgeon’s training and experience, including their specific (sub-specialty) experience with oesophagogastric cancer surgery and procedures to be undertaken, should be available.

There is strong evidence, including published studies from Australia, that higher volume hospitals (defined as performing at least six oesophagectomies per year) have better clinical outcomes following oesophageal cancer surgery (Davis et al. 2018; Meng et al. 2019; Narendra et al. 2019; Ross et al. 2014).There is also strong evidence internationally that high-volume hospitals have better outcomes for gastric cancer.

International evidence suggests that surgeons who undertake a higher volume of resections have better clinical outcomes for complex cancer surgery such as oesophagogastric resections, although institutional volume is likely to be a more important factor than the individual surgeon (Gruen et al. 2009; Killeen et al. 2005). Patients undergoing oesophagogastric cancer surgery should be treated at specialist centres that have teams that deliver integrated expertise in endoscopy, imaging, interventional radiology, surgery and histopathology, and treat a high volume of these cases. Centres that do not meet this criteria should routinely refer cases to a centre with experience in that type of case.

Health service unit characteristics

To provide safe and quality care for patients having surgery, health services should have these features:

• appropriate ward staff including nursing, dietetics, physiotherapy, occupational therapy and theatre resources to manage complex surgery
• 24-hour medical staff availability
• 24-hour operating room access
• an intensive care unit with nursing and medical staff who are familiar with oesophagogastric surgery
• 24-hour access to interventional radiology fully supported by other surgical specialties
• specialist anaesthetists (Narendra et al. 2019)
• diagnostic imaging and interventional radiology
• pathology
• nuclear medicine imaging
• advanced endoscopy services.

Each unit performing complex oesophagogastric cancer surgery must demonstrate robust audit processes, and benchmarking of outcomes, to ensure quality outcomes are delivered consistently.