References for this review were identified by searches of PubMed. Search criteria included the terms “esophageal neoplasm”, “esophagectomy”, “transhiatal”, “transthoracic”, “minimally invasive surgery”, “laparoscopy” or “laparoscopic”, “thoracoscopy” or “thoracoscopic”, “radiotherapy”, “chemotherapy”, “chemoradiotherapy”, and “multimodality therapy”. Selected papers from the search results were retrieved and only papers involving human studies, published in English, were used for this review.
ReviewThe role of surgery in the management of oesophageal cancer
Section snippets
Extent of surgery
There is considerable debate about whether modification of operative techniques, eg, reducing radicality or residual disease, can substantially change the outcome. Issues which remain particularly controversial are the optimum surgical approach, the extent of lymph-node dissection, and the value of using minimally invasive techniques.
Surgery as part of combined modality therapy
The equivalence between incidence and mortality rates in the USA for oesophageal cancer4 and the failure of surgery alone to alter this pattern means that many oncologists favour combined modality therapy. As a consequence, chemo-radiotherapy, either with or without surgery, is the most widely used treatment for patients with oesophageal cancer in the USA.57 We have chosen to critically analyse the data from available clinical trials to find out whether this trend in treatment is justified or
Definitive chemoradiotherapy
The traditional role of surgery in the management of oesophageal cancer has further been challenged by the results of a phase III trial examining the usefulness of definitive chemoradiotherapy. In RTOG 8501,72 patients were randomised to receive chemoradiotherapy or radiotherapy alone; neither treatment group underwent surgery. The results imply that chemoradiotherapy is superior to radiotherapy—26% of patients in the combined modality group were alive at 5 years compared with no patients who
Conclusions
The management of oesophageal cancer will undoubtedly continue to evolve as improvements in technology, combined with a greater understanding of genomics and biology of tumours, better define effective therapeutic interventions and allow introduction of novel treatments into strategies for clinical management. The role of surgery is likely to change over time, but will continue as a primary, or secondary, treatment modality for a substantial number of patients with oesophageal cancer. In
Search strategy and selection criteria
References (73)
- et al.
Barrett's esophagus. A prevalent, occult complication of gastroesophageal reflux disease
Gastroenterology
(1987) - et al.
Endoluminal palliation for dysphagia secondary to esophageal carcinoma
Surg Clin North Am
(2002) - et al.
Methods of palliation of esophageal and gastric cancer
Surg Oncol Clin N Am
(2002) - et al.
Inoperable adenocarcinoma of the oesophagogastric junction: a comparative clinical study of laser coagulation versus self-expanding metallic stents with special reference to cost analysis
Eur J Surg Oncol
(2002) - et al.
Endoscopic palliation of malignant dysphagia
Mayo Clin Proc
(2001) - et al.
A prospective randomized comparison of transhiatal and transthoracic resection for lower-third esophageal carcinoma
Am J Surg
(1997) - et al.
Transthoracic versus transhiatal resection for carcinoma of the esophagus: a meta-analysis
Ann Thorac Surg
(2001) Esophageal surgery at the end of the millennium
J Thorac Cardiovasc Surg
(1998)- et al.
Prognostic factors of resected adenocarcinoma of the esophagus
Surgery
(1995) - et al.
Intraoperative lymphatic mapping and sentinel lymph node sampling in esophageal and gastric cancer
Surg Oncol Clin N Am
(2002)
Occult cervical nodal metastasis in esophageal cancer: preliminary results of three-field lymphadenectomy
J Thorac Cardiovasc Surg
Indications for three-field dissection followed by esophagectomy for advanced carcinoma of the thoracic esophagus
J Thorac Cardiovasc Surg
Node status in transmural esophageal adenocarcinoma and outcome after en bloc esophagectomy
J Thorac Cardiovasc Surg
Evaluation of neck lymph node dissection for thoracic esophageal carcinoma
Ann Thorac Surg
A prospective randomized trial of extended cervical and superior mediastinal lymphadenectomy for carcinoma of the thoracic esophagus
Am J Surg
Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett's esophagus
Gastroenterology
High-frequency probe EUS-assisted endoscopic mucosal resection: a therapeutic strategy for submucosal tumors of the GI tract
Gastrointest Endosc
Minimally invasive esophagectomy
Ann Thorac Surg
Use of minimally invasive oesophagectomy for cancer of the oesophagus
Lancet Oncol
Combined modality therapy of esophageal cancer—standard of care?
Surg Oncol Clin N Am
Low dose preoperative radiotherapy for carcinoma of the oesophagus: results of a randomized clinical trial
Radiother Oncol
Preoperative chemotherapy versus surgical therapy alone for squamous cell carcinoma of the esophagus: a prospective randomized trial
J Thorac Cardiovasc Surg
Randomized clinical trial of preoperative and postoperative adjuvant chemotherapy with cisplatin, vindesine, and bleomycin for carcinoma of the esophagus
J Thorac Cardiovasc Surg
Rising incidence of adenocarcinoma of the esophagus and gastric cardia
JAMA
Changing patterns in the incidence of esophageal and gastric carcinoma in the United States
Cancer
The changing epidemiology of esophageal cancer
Semin Oncol
Cancer statistics, 2002
CA Cancer J Clin
Esophageal carcinoma: current controversies
Semin Surg Oncol
Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma
N Engl J Med
Association between body mass and adenocarcinoma of the esophagus and gastric cardia
Ann Intern Med
Body mass index and risk of adenocarcinomas of the esophagus and gastric cardia
J Natl Cancer Inst
Obesity, alcohol, and tobacco as risk factors for cancers of the esophagus and gastric cardia: adenocarcinoma versus squamous cell carcinoma
Cancer Epidemiol Biomarkers Prev
Analysis of reduced death and complication rates after esophageal resection
Ann Surg
Factors affecting morbidity, mortality, and survival in patients undergoing Ivor Lewis esophagogastrectomy
Ann Surg
Transhiatal esophagectomy: clinical experience and refinements
Ann Surg
Curative resection for esophageal adenocarcinoma: analysis of 100 en bloc esophagectomies
Ann Surg
Cited by (238)
Three-Field Lymphadenectomy in Minimally Invasive Esophagectomy for Squamous Cell Carcinoma
2021, Annals of Thoracic SurgeryEsophageal squamous cell carcinoma metachronous to head and neck cancers
2021, Pathology Research and PracticeCitation Excerpt :The prognosis of locally advanced disease is poor, despite the aggressiveness of treatments, with a five-year survival rate varying from 15 % to 39 % [2]. Esophagectomy accounts for up to 35 % of curative resections, despite the high incidence of complications [3–5]. Esophageal cancer may be associated with previous, synchronous or metachronous cancer at other primary sites and this association may further affect patients’ prognosis [6].
Comparison of QoL Between Substernal and Posterior Mediastinal Routes in Esophagogastrostomy
2021, Journal of Gastrointestinal SurgeryAdvances in conduits and anastomotic techniques employed in esophageal cancer resections: A review
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2022, World Journal of Surgical OncologyMapping of Lymph Node Metastasis From Thoracic Esophageal Cancer: A Retrospective Study
2022, Annals of Surgical Oncology