Surgical Approaches to Oesophageal Carcinoma: Evolution and Evaluation

Abstract

Oesophageal cancer is a virulent malignancy and continues to represent a formidable challenge for both patients and clinicians. Surgical resection remains the most definitive form of treatment whether performed alone or in combination with chemotherapy and radiation therapy as part of a multimodality treatment strategy. There are several controversies in the surgical management of oesophageal cancer including the surgical approach, extent of resection, optimal fields of lymph node dissection, and the ideal location of anastomosis. Multiple approaches have been described for esophagectomy, which can be thematically grouped under two major categories: either transthoracic or transhiatal. The main controversy rests on whether a more extended resection through thoracotomy provides superior oncological outcomes as opposed to resection with relatively limited morbidity and mortality through a transhiatal approach. After numerous trials that have addressed these issues, neither approach has consistently proven to be superior to the other one, and both can provide excellent short-term results in the hands of experienced surgeons. At present, the trend is towards minimally invasive surgery in search of a better outcome as well as quality of life.