Surgery, radiotherapy, and chemotherapy for esophageal cancer

Although it is generally accepted that surgery offers the only chance of cure for esophageal cancer, there is still no consensus regarding the optimal operative treatment. Data from specialized centers indicate that radical esophagectomy with two-field or three-field lymphadenectomy can be performed with low perioperative morbidity and mortality. Although such extended lymphadenectomies clearly lead to accurate staging, the therapeutic impact of these procedures is still a matter of debate. In order to tailor the extent of resection or neoadjuvant therapy to the tumor stage of the individual patient, preoperative staging is important, Early results on the role of diagnostic laparoscopy and video-assisted thoracoscopy have become available. The interest in performing minimally invasive esophagectomies is waning for various reasons, Even extensive surgical therapy has unsatisfactory long-term results. The majority of patients develop locoregional or:distant tumor recurrence, Several (neo)adjuvant therapy trials have been performed, but none have proven to be effective. In general, there is a shift in interest from adjuvant to neoadjuvant therapy (especially combined chemo- and radiotherapy). Unfortunately, most institutions report nonrandomized phase II trials with a great variety of therapeutic regimens. Moreover, interpretation is frequently hampered because the various tumor stages are poorly defined and because no clear distinction is made between squamous cell carcinomas and adenocarcinomas.