The 2025 American Association for Thoracic Surgery (AATS) Expert Consensus Document: Surgical Management of Esophageal and Gastroesophageal Junction Cancer.

Objective: Esophagectomy has been a cornerstone of the treatment of nonmetastatic esophageal cancer, but its use has evolved with advances in endoscopic resection techniques, systemic therapy, and radiation. This document reviews the existing literature and reports multidisciplinary consensus and specific recommendations on how best to treat esophageal and gastroesophageal junction cancer at different stages, including difficult clinical scenarios.

Methods: The American Association for Thoracic Surgery Clinical Practice Standards Committee assembled an international, multidisciplinary panel of gastroenterologists, medical oncologists, radiation oncologists, surgical oncologists, and thoracic surgeons with established esophageal and gastroesophageal junction cancer management expertise. A focused literature review was performed with the assistance of a medical librarian. The panel used a modified Delphi method to develop expert consensus statements with a class of recommendations and level of evidence for 3 topics: early-stage adenocarcinoma, locally advanced adenocarcinoma, and squamous cell carcinoma.

Results: Consensus was reached on 23 recommendations, reflecting insights based on the latest literature and current clinical experience that focused on disease stage and histology. The recommendations provide input on the role of surgery, endoscopic therapy, and surveillance for early-stage adenocarcinoma, how to best combine surgery with multimodality therapy for locally advanced adenocarcinoma, and when surgery should be used for patients with squamous cell carcinoma.

Conclusions: Despite the complex nature of esophageal cancer management, consensus on several key recommendations was achieved by this American Association for Thoracic Surgery expert panel. These recommendations, based on evidence and developed using the modified Delphi method and expert opinion, provide guidance for thoracic surgeons and other medical professionals who care for esophageal cancer patients.