Background There are conflicting opinions on the role of Endoscopic Ultrasound (EUS) in the staging of oesophageal cancer (OG) patients which can complicate and delay intervention. We aim to audit the use of EUS in the OG cancer staging pathway as well as assess accuracy in selected cases. Methods A retrospective audit of the hospital database of patients diagnosed with oesophageal carcinoma between January 2016 and March 2021.The duration between the first MDT and EUS performed was calculated. Concordance between initial CT and EUS stage as well as histology in patients that were offered direct to surgery were evaluated using Cohen's Weighted Kappa. Results A total of 301 patients were identified. Overall, there was a moderate agreement (K=0.526) between CT and EUS reported T Staging(p<0.001). There was substantial agreement (K=0.798) between CT reporting T2, T3 and EUS(p<0.0005). Twenty-seven patients underwent upfront surgery-11 were T1, 16 were T2 and T3 disease. Comparing to final histology, EUS reported an accurate T1 stage in 36.3% compared with 0% with CT (p=0.018), whereas T2 and T3 disease were accurately reported with EUS and CT in 43.7% and 37.5% respectively (p=0.375). The median number of days between first MDT and EUS was 14 days (8,18) and this was requested after CT and PET CT results were available in 80% of cases. Conclusions This audit demonstrates minor differences between EUS and CT for T2 and T3 disease and therefore unlikely to alter management. However, EUS is superior to CT for staging Tx and T1 disease and is therefore likely to impact on the treatment options. EUS also contributed to prolonged pre-treatment staging time. Adopting a selective approach to EUS could result in overall reduction of waiting times from referral to decision making and increase cost-effectiveness.

Introduction The left thoracophrenotomy approach to oesophagectomy or Sweet Oesophagectomy (SO) for oesophageal cancer is performed by many centres worldwide but seldom used in UK, owing to concerns over extent of lymphadenectomy compared with Ivor-Lewis oesophagectomy (ILO) approach. This study aims to compare oncological and clinical outcomes following the Sweet approach with ILO. Methods A retrospective, single centre study was conducted, analysing all patient data following the SO approach and ILO for oesophageal cancer between August 2012 - March 2021. Results The total number who underwent the Sweet (SO) operation and ILO was 72 and 197 patients respectively.91.7% vs 80.2%, p=0.071 were distal oesophageal tumours. Median lymph node count were 22 and 23 respectively, p=0.980. The Sweet was associated with 69.4% circumferential, 94.4% proximal and 95.8% distal R0 resections compared with 72.6% (p=0.365, 98%(p=0.132) and 96%(p=0.330) with ILO resection, respectively. Median operative time was 169 vs. 301 minutes for Sweet and ILO respectively, p<0.001. The overall complication rate was 29.2% with the Sweet and 45.7% with ILO, p=0.015, including, Anastomotic leaks 0 vs. 11, p=0.041 And return to theatre 1 vs. 22, p=0.04. The 30, 90 day and 5-year survival was 100% vs. 99%(p=0.391), 98.6% vs. 95.9% (p=0.281) & 51.4% vs. 50.3% (p=0.869), respectively. Conclusion The Sweet procedure was associated with comparable oncological efficacy and survival to ILO. Furthermore, was associated with significantly shorter operative time and lower complication rates, therefore should be considered in selected cases. Take-home message Left thoracotomy oesophagectomy remains an appropriate option with significantly better results in our centre, in the management of lower oesophageal and junctional carcinoma as compared to ILO. Having a reduced hospital stay and operative time may be more favourable in more frail patients with distal and junctional oesophageal tumours.

The left thoracophrenotomy approach to oesophagectomy-also known as Sweet Oesophagectomy (SO)—for oesophageal cancer is performed by many centres worldwide but seldom used in the UK, owing to concerns over the extent of lymphadenectomy compared with the Ivor-Lewis oesophagectomy (ILO) approach. This study aims to compare the oncological and clinical outcomes following the Sweet approach with ILO. A retrospective, single centre study was conducted, analysing all patient data following the SO approach and ILO for oesophageal cancer between August 2012 and March 2021. Total number offered the Sweet and ILO were 72 and 197 patients respectively. 91.7% vs 80.2%, p = 0.071 were distal tumours. Median node count were 22 and 23 respectively, p = 0.980. The Sweet was associated with 69.4% circumferential, 94.4% proximal and 95.8% distal R0 resections compared with 72.6% (p = 0.365), 98% (p = 0.132) and 96% (p = 0.330) with ILO resection, respectively. Median operative time was 169 vs. 301 minutes for Sweet and ILO respectively, p < 0.001. Overall complication rate was 29.2% with Sweet and 45.7% with ILO, p = 0.015, including, Anastomotic leaks 0 vs. 11, p = 0.041, return to theatre 1 vs. 22, p = 0.04. The 30-day, 90-day and 5-year survival was 100% vs. 99% (p = 0.391), 98.6% vs. 95.9% (p = 0.281) & 51.4% vs. 50.3% (p = 0.869), respectively. The Sweet procedure was associated with comparable oncological efficacy and survival to ILO. Furthermore, was associated with significantly shorter operative time and lower complication rates, therefore should be considered in selected cases. Having a reduced hospital stay and operative time may be more favourable in more frail patients with distal and junctional oesophageal tumours.