Episode # 3 • 17 Jan 2025
Perioperative Management in Upper GI Cancers
How do you choose between perioperative chemotherapy and trimodality therapy for a patient with localized upper GI cancer, and what has the newest data actually settled? On this episode of BackTable Tumor Board, host Dr. Kate Baker interviews Dr. Dani Castillo, a medical oncologist at City of Hope in Duarte, California, and Dr. Alexandra Gangi, a gastrointestinal surgical oncologist at Cedars-Sinai in Los Angeles, about everything that happens between a new diagnosis and a resection in localized esophageal, gastroesophageal junction and gastric cancer. They cover diagnostic workup, Siewert classification, staging laparoscopy, histology, biomarker testing, surgical candidacy, and the challenges of nutrition and prehabilitation.
Timestamps
00:00 - Introduction
01:42 - Diagnostic Workup and Siewert Classification
04:20 - Histology, Risk Stratification, and Biomarkers
07:03 - Surgical Candidacy and Preoperative Optimization
10:26 - Perioperative Chemotherapy versus Trimodality Therapy
13:37 - Chemotherapy Tolerability, Immunotherapy, and Dose Reduction
15:10 - Gastrectomy, Esophagectomy, and Recovery
20:05 - Pathologic Response and Adjuvant Decisions
21:55 - Organ Preservation and ctDNA
24:54 - Future Directions and Ongoing Trials
26:35 - Multidisciplinary Care and Community Practice
27:40 - Closing Remarks
Resources
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More about this episode
The conversation tackles the choice between perioperative chemotherapy and chemoradiation, when to add immunotherapy, and the latest data from ESOPEC and MATTERHORN. Dr. Gangi explains why subtotal versus total gastrectomy, anastomotic technique, and node dissection matter for recovery. The team discusses the role of organ preservation, ctDNA for de-escalation, and why multidisciplinary care remains essential even in smaller community practices. The episode closes with real-world strategies for managing frailty, dose reduction, and ensuring patients and providers are aligned before heading to the OR and why upper GI cancer stays a multidisciplinary disease even where the team is small.
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