Cáncer de esófago: diferencias entre Occidente y Oriente

Diferencias en el abordaje del cáncer de esófago entre las guías occidentales y asiáticas

Differences in the management of esophageal cancer between Western and Eastern guidelines

J. Martínez Caballero*, P. Vázquez Beltrán*, N. Lara Martín*, R. Lara Tomé*, P. Gómez Rodríguez*, E. Rodríguez Cuellar*

* Servicio de Cirugía General, Aparato Digestivo y Trasplante de
     Órganos Abdominales. Unidad de Cirugía Colorrectal.
     Hospital Universitario 12 de Octubre. Madrid (España).

DOI: https://doi.org/10.14679/4565

Resumen:

Existen diferencias sustanciales en el abordaje del cáncer de esófago entre las guías clínicas orientales y occidentales, determinadas por factores epidemiológicos, histológicos y organizativos. Mientras que en Asia predomina el carcinoma epidermoide (CE), más frecuente en el esófago medio y diagnosticado precozmente gracias a programas de cribado endoscópico, en Occidente predomina el adenocarcinoma (AC), asociado al esófago de Barrett y diagnosticado en estadios más avanzados. Estas diferencias influyen en la estrategia terapéutica.
En el CE, las guías asiáticas priorizan la linfadenectomía extensa de tres campos y la quimioterapia preoperatoria (DCF), mientras que en Occidente se opta por la QT-RT neoadyuvante (esquema CROSS) seguida de cirugía. En el AC, el esquema perioperatorio FLOT ha desplazado progresivamente a la QT-RT en Europa y EE. UU., mientras que en Asia se emplean esquemas como SOX o DOS. La ecoendoscopia y la PET-TC son pilares en la estadificación occidental, frente a la endoscopia de alta definición en Oriente.
El uso creciente del abordaje mínimamente invasivo y las técnicas robóticas es común a ambas regiones, aunque con distinto grado de implementación. La inmunoterapia adyuvante con nivolumab tras tratamiento neoadyuvante ha sido incorporada en ambas regiones, marcando un hito en el tratamiento personalizado. En conjunto, el futuro del cáncer esofágico exige una integración racional de ambos modelos, combinando precisión técnica y estrategia multimodal.
Palabras Clave: Cáncer de esófago; carcinoma epidermoide; adenocarcinoma; guías clínicas; tratamiento multimodal; linfadenectomía; cirugía mínimamente invasiva.

Abstract:

There are significant differences in the management of esophageal cancer between Eastern and Western clinical guidelines, driven by epidemiological, histological, and healthcare system factors. In Asia, squamous cell carcinoma (SCC) predominates, typically affecting the mid-esophagus and often diagnosed at early stages due to organized endoscopic screening programs. In contrast, adenocarcinoma (AC) is more common in Western countries, often related to Barrett’s esophagus and diagnosed at more advanced stages. These distinctions influence therapeutic strategies.
For SCC, Eastern guidelines favor three-field lymphadenectomy and preoperative chemotherapy (DCF regimen), while Western protocols often recommend neoadjuvant chemoradiotherapy (CROSS protocol) followed by surgery. In AC, the perioperative FLOT regimen has gradually replaced CROSS in Europe and the U.S., whereas Asian countries adopt regimens like SOX or DOS. Endoscopic ultrasonography and PET-CT are central to staging in Western practice, whereas high-definition endoscopy is prioritized in Asia.
Minimally invasive and robotic approaches are increasingly adopted in both regions, though to varying extents. Adjuvant immunotherapy with nivolumab after neoadjuvant therapy and R0 resection has been incorporated into both Eastern and Western guidelines, representing a major advance in personalized oncology. Overall, the future of esophageal cancer management depends on the rational integration of both paradigms—combining the technical precision of the Eastern approach with the multimodal flexibility and innovation of Western practice.
Key words: Esophageal cancer; squamous cell carcinoma; adenocarcinoma; clinical guidelines; multimodal treatment; lymphadenectomy; minimally invasive surgery.

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