Surgical concepts in esophageal cancer

Abstract

Despite neoadjuvant treatment being available for esophageal cancer, surgery remains the cornerstone of treatment. The aim of this article is to give a clear and simple overview of current issues in the available surgical strategies relating to locally limited and advanced disease, including the following: clinical staging, preoperative general condition and comorbidities, surgical strategy, surgical approaches, postoperative complications and the role of surgery in advanced disease. Based on a literature search and our personal professional experience to date, enhanced surgical treatment protocols for the treatment of the adenocarcinomas of esophagogastric junction (AEG) and the squamous cell carcinoma of the esophagus are presented and discussed. Eligibility for a surgical resection strongly depends on the stage of the tumor and on the comorbidities. A minimally invasive laparoscopic approach should be preferred in the case of limited disease, regardless of its histology, or limited/advanced intrathoracic squamous cell carcinoma (hybrid technique: laparoscopic approach combined with thoracotomy). The surgical strategy in the case of adenocarcinoma to achieve radical resection depends on the tumor location. Finally, surgery should be performed by a multidisciplinary team that includes medical oncologists, radiation oncologists, gastroenterologists, dieticians and physiotherapists, so as to minimize the postoperative complications rates and improve early postoperative outcomes and overall patient survival. Therefore, we support the centralization of treatment of esophageal cancer to high volume centers.