ESOPHAGEAL CANCER AND GASTROESOPHAGEAL REFLUX DISEASE: CLINICAL INTERVENTIONS AND SURGICAL EVALUATION

Abstract

Introduction: Esophageal cancer, a malignant neoplasm that affects the tube that connects the pharynx to the stomach, has an increasing incidence globally. One of the best-established risk factors for the development of this type of cancer is gastroesophageal reflux disease (GERD), a chronic condition characterized by the reflux of gastric contents into the esophagus. GERD promotes inflammatory and proliferative changes in the esophageal mucosa, predisposing to the development of neoplasms. Given the complexity of this relationship and the importance of effective interventions, this systematic review seeks to explore the scientific evidence on clinical interventions and surgical evaluation in the context of esophageal cancer and GERD. Objective: The objective of this systematic review was to synthesize the available scientific evidence on the different clinical interventions and surgical evaluation in patients with esophageal cancer and GERD, in order to identify best practices and direct future research. Methodology: A systematic review of the literature was performed, following the principles of the PRISMA statement. The search for articles was conducted in the PubMed, Scielo and Web of Science databases, using the following descriptors: "esophageal cancer", "gastroesophageal reflux disease", "surgical intervention", "clinical management" and "complications". Original studies published in the last 10 years, in English or Portuguese, that evaluated clinical or surgical interventions in patients with esophageal cancer and GERD were included. The exclusion criteria were: reviews, case studies, letters to the editor and studies with inadequate methodological design. Results: The analysis of the included studies revealed that GERD is a significant risk factor for the development of esophageal adenocarcinoma, with esophagectomy being the main surgical approach for the treatment of esophageal cancer. Clinical interventions, such as drug therapy with proton pump inhibitors, have shown efficacy in reducing GERD symptoms and preventing progression to adenocarcinoma in patients with Barrett's esophagus. However, the choice of the best therapeutic approach depends on several factors, including the stage of the disease, the patient's comorbidities, and individual preferences. Conclusion: The relationship between GERD and esophageal cancer is complex and multifactorial. Early identification of GERD and implementation of preventive measures, such as control of risk factors and appropriate treatment of symptoms, are crucial to reduce the incidence of esophageal cancer. The choice of the best therapeutic approach for each patient should be individualized, considering the benefits and risks of each intervention. Future studies are needed to elucidate the molecular mechanisms involved in the progression of GERD to cancer and to develop new, more effective therapeutic strategies.