Role Of Surgery In Management Research Articles

838. The Role of Surgery in the Management of Invasive Fungal Rhinosinusitis Complicated by Orbitocranial Extension in the Era of Azole Antifungals

Abstract Background Orbitocranial fungal infection (OCFI) is a potentially lethal complication of fungal rhinosinusitis, historically requiring aggressive surgery despite its significant morbidity. Over the past two decades, early use of azole agents has been introduced to support amphotericin B formulations as first-line treatment followed by step down therapy with azoles, demonstrating promising outcomes. To date, there is no data regarding the contribution of surgery in the “azole era” to patients’ survival. We aimed to provide real-life data on azole treatment outcomes and the role of surgery in the current management of OCFI. Methods Data was collected retrospectively from a chart review of the four tertiary participating centers in Israel and Australia between January 1, 2009 and January 1 2020, as well as additional cases identified through a systematic literature review (Fig. 1). The study group included patients with OCFI treated with azole antifungals. Control cases were all treated with amphotericin B. The cranial and orbital involvement was staged based on imaging (Fig. 2). The extent of surgical resection was also classified to allow for inter-group comparison. Flowchart for identification, screening, eligibility, and inclusion for the systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Staging of orbitocranial fungal infection used in the study and T1 contrast-enhanced magnetic resonance images illustrating each stage I. Orbital extent: orA - periorbit, lacrimal apparatus; orB - orbital fat; orC - oculomotor muscles; orD – optic nerve, eyeball. II. Cranial extent: crA - pterygopalatine fossa, nasopharynx; crB – temporal/infratemporal fossa; crC – cavernous sinus, dura; crD – brain, spinal cord. Results There were 125 patients in the azole anti-fungal (AAF) group and 153 in the control group (Table 1). Mucorales and Aspergillus were identified in 28% and 72% of AAF cases, respectively, and 67% and 33% of control cases, respectively (p< 0.001). Among patients with cranial extension, 22.6% were operated on in the AAF group and 18.4% in the control group (Table 2). However, meninges and brain resection were performed only in the controls (10.5%) and never in the azole antifungals group (p=0.045). Orbital involvement required surgery in 25.9% of AAF cases and 38.6% of controls (p=0.12). Despite a more aggressive cranial involvement, azole-treated patients’ 3-year mortality was significantly lower than controls (21% vs. 52%, HR 0.27, p< 0.001, Fig. 4). Comparison of the study groups according to the orbitocranial fungal infection extent a. cranial extent; b. orbital extent Kaplan Meier curve on the orbitocranial fungal infection specific survival during up to 3 years of follow-up *Categorical variables are presented in n (%); **Continuous variables are represented as mean (±SD); ªAcquired immunodeficiency syndrome; bHematologic disease leading to immune compromised status; *Including 6 patients with both Mucorales and Aspergillus Univariate analysis of the study groups' main characteristics Conclusion Despite less aggressive surgical intervention for cranial involvement, OCFI patients treated with azoles had a higher survival rate, suggesting we may improve morbidity with a more conservative surgical approach in conjunction with azole treatment. The same trend is emerging for orbital involvement. Surgery for rhino-orbital-cerebral mycosis patients. Disclosures Sharon C. Chen, PhD MBBS, F2G PTy LTd: Advisor/Consultant|F2G PTy LTd: Grant/Research Support

Role of surgery in management of intracranial dural arteriovenous fistulas.

Intracranial dural arteriovenous fistulas (DAVF) are abnormal connections between intracranial arterial and venous systems within the dural layers. Intracranial DAVFs are rare but can occur wherever dural components exist. The pathogenesis of DAVFs is controversial. Venous hypertension is considered as a main cause of clinical symptoms which are subclassified into asymptomatic, benign and aggressive manifestations. To date, several classification schemes have been proposed to stratify the natural course and risks of DAVFs. Currently, endovascular therapy is the main treatment modality. Moreover, the use of radiosurgery and radiotherapy has been limited. Open surgery is also selectively performed as a main treatment modality for specific types of DAVFs and an adjunctive modality for the endovascular approach. Herein, we present a review of the general perspectives of intracranial DAVFs with an emphasis on the role of surgery.

ASO Author Reflections: What Is the Role of Surgery in Management of In-Transit Melanoma in the Modern Era?

ASO Author Reflections: What Is the Role of Surgery in Management of In-Transit Melanoma in the Modern Era?

Randomized Trial of Cytoreductive Surgery for Relapsed Ovarian Cancer

(Abstracted from N Engl J Med 2021;385:2123–2131) Standard of care treatment for advanced ovarian cancer involves primary macroscopic resection of all tumor followed by platinum-based combination chemotherapy with or without additional systemic therapy including bevacizumab or a poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitor. The Descriptive Evaluation of Preoperative Selection Criteria for Operability in Recurrent Ovarian Cancer (DESKTOP) series aims to assess the role of surgery in management of recurrent ovarian cancer.

Surgical Management of Rhabdomyosarcoma of the Nasal Cavity and Paranasal Sinuses: Analysis of Operative Indications, Settings, and Outcomes.

Objectives The role of surgery in management of sinonasal rhabdomyosarcoma (SNRMS) has traditionally been limited, owing to anatomic and technological challenges and the established role of systemic therapy. Herein, we report our institutional experience with surgical management of SNRMS, with a particular focus on operative approaches, extent and outcomes. Design This study is a retrospective cohort study. Setting This study was conducted at a single-institution, academic center. Participants Patients of any age with histologically confirmed RMS of the nasal cavity, maxillary, ethmoid, frontal, or sphenoid sinus, nasolacrimal duct, or nasopharynx presenting between 1994 and 2020 were included in this study. Main Outcome Measures Demographics, tumor characteristics, operative settings, complications and recurrence, and survival outcomes were the primary outcomes of this study. Results Our study cohort comprised of 29 patients (mean [range] age: 27.0 [3.1-65.7], n = 12 [41%] female). Tumors of the nasal cavity ( n = 10, 35%) and ethmoid sinuses ( n = 10, 35%) and those with alveolar histology ( n = 21, 72%) predominated. Patients who had surgery as part of their treatment ( n = 13, 45%) had improved distant metastasis-free survival (DMFS) overall (hazard ratio [HR]: 0.32, 95% CI: 0.11, 0.98, p = 0 .05 ) as compared with those who did not have surgery. Surgical approaches included open ( n = 7), endoscopic ( n = 4), and combined ( n = 2). Eight of these 13 patients (62%) had an R0 resection. Additionally, surgical salvage of recurrent disease was employed in five patients (17%). Conclusion SNRMS is an aggressive malignancy with a high rate of recurrence and spread requiring a multidisciplinary approach for optimal outcomes. Our data supports an expanding role for surgery for SNRMS given its feasibility, tolerability, and potential to improve outcomes.

Tumeur stromale gastro-intestinale à localisation jéjunale : Une rare cause de masse abdominale chez la femme âgée

INTRODUCTION : Nous rapportons le cas d’une patiente présentant une masse abdominale dont le diagnostic final est une tumeur stromale gastro-intestinale (GIST). OBSERVATION : Il s’agissait d’une patiente âgée de 61 ans sans antécédents pathologiques, reçue pour une augmentation progressive de volume de l’abdomen évoluant depuis un an, indolore. A l’examen, la patiente avait un bon état général, des constantes normales. Nous notions une masse abdomino-pelvienne d’environ 20 cm de grand axe, mobile. Le reste de l’examen était sans particularité. Le bilan biologique était normal. La tomodensitométrie abdominopelvienne mettait en évidence une masse tissulaire avec des remaniements nécrotiques. Une indication opératoire a été posée. A l’exploration, nous notions une masse développée sur le bord mésentérique à 45 cm de l’angle de Treitz. Elle n’est pas associée à de l’ascite ou à une carcinose péritonéale. Il n’y avait pas de lésion hépatique également. La résection intestinale emportant la masse a été réalisée suivie d’une anastomose termino-terminale. Les suites opératoires étaient simples. L’examen anatomo-pathologique de la pièce opératoire a posé le diagnostic d’une GIST. L’évolution post-opératoire à trois mois était excellente tant sur le plan clinique que radiologique. CONCLUSION : Le cas que nous rapportons souligne la possibilité de retrouver une GIST à localisation jéjunale malgré une présentation clinique peu usuelle. Elle montre également la difficulté d’obtenir un diagnostic préopératoire et le rôle central de la chirurgie dans la prise en charge.

The Role of Surgery in Management of Primary Metatarsus Adductus

Background: Metatarsus adductus is the most common congenital foot deformity in children. Different bone surgical procedures were portrayed to treat severe cases of fixed metatarsus adduction. Objective: To establish a protocol for diagnosis and treatment of forefoot adduction deformity in metatarsus adductus, and to evaluate the results of double column osteotomy (closing wedge cuboid osteotomy and opening wedge medial cuneiform osteotomy) (i.e. lateral column shortening with medial column lengthening) in correction of the foot deformity. Patients and Methods: In this prospective study 16 patients with 17 feet with fixed metatarsus adductus were operated upon for forefoot adduction deformity in Zagazig University Hospitals since 2018. 10 boys and 6 girls from 4-12 years old. The right foot was operated upon in 7 patients and the left foot in 10 patients. All cases underwent double column osteotomy; closing wedge cuboid osteotomy and opening wedge medial cuneiform osteotomy. Results: According to the grading system applied in this study, there were twelve cases with excellent results (nearly 70%). There was no pain throughout the foot. The forefoot adduction deformity was completely corrected. There was no supination in all cases. All cases manifested no complaints of the footwear or braces. All cases were satisfied and their parents revealed gratification of the foot shape and gait. There were 3 good results (18%), 2 fair results (12%), and no poor result. Conclusion: Double column osteotomy (combined cuboid/cuneiform osteotomy) is a safe operation, which allows satisfying correction of forefoot adduction deformity in severe rigid metatarsus adductus.

Acute upper gastrointestinal bleeding: A review

Abstract Gastrointestinal haemorrhage is potentially life threatening. Resuscitation, clinically diagnosing and treating the underlying problem are the principles of management. As most gastrointestinal haemorrhage cease spontaneously, there is greater importance in non- operative intervention. Radio-embolisation is a growing useful adjunct in available armamentarium for non-operative management. The definitive management of upper GI hemorrhage is indicated by the overall risk of re-bleeding and morbidity (Rockall risk score). Failure to respond to endoscopic and medical management is an indication for urgent surgery. New endoscopic techniques and radiological embolisation have decreased the role of surgery in management, but collaboration between the endoscopist and the surgeon remains.

Acute gastroinstinal bleeding: a review

Blood loss from the gut may be acute requiring emergency resuscitation, investigation, and management, or chronic and occult resulting in anemia. The upper gastrointestinal (GI) tract is more commonly a source of hemorrhage than the lower GI tract. Endoscopy is the mainstay of investigation and management. New endoscopic techniques and radiologic embolization have decreased the role of surgery in management, but collaboration between the endoscopist and the surgeon remains. In this review the management of acute blood loss in the GI tract is discussed. The importance of resuscitation, clinically diagnosing, and treating the underlying problem is emphasized.

ACTR-28. A CALL FOR INCREASED ROLE OF NEUROSURGEONS IN SURGICAL TRIALS FOR NON-GLIOMATOUS PRIMARY CNS TUMORS: A SYSTEMATIC REVIEW OF THE CLINICALTRIALS.GOV DATABASE

Abstract BACKGROUND Surgery continues to be part of the mainstay of therapy for most primary CNS tumors. However, neurosurgical innovations advancing treatment options have stagnated. An understanding of past and current investigational trends is necessary to catalyze innovation in surgical trials. OBJECTIVE To evaluate the landscape of surgical clinical trials for non-diffusely infiltrating primary CNS tumors. METHODS ClinicalTrials.gov was searched on May 14th, 2019 for surgical/procedural trials based on non-diffusely infiltrating primary CNS tumors, with a focus on meningiomas, ependymomas, medulloblastomas, pituitary adenomas, vestibular scwhannomas, and chordomas. Key trial design parameters were extracted. Purely surgical interventions were classified as “technical” while fluorescence-guided and other intraoperative imaging modalities were classified as image-guided surgery. Any invasive mode of drug delivery (e.g. intra-arterial or intra-ventricular, local chemotherapy wafers, and oncolytic virus injection) was considered. RESULTS Among 944 total trial records (257 medulloblastomas, 254 ependymomas, 179 meningiomas, 156 pituitary adenomas, 56 vestibular schwannomas, and 48 chordomas) only 54 (5.7%) were procedural in nature. Ependymomas had the highest absolute number (18/254, 7%) while vestibular schwannomas had the highest percentage (6/56, 10.7%) of surgical trials. The majority of records were not randomized (41/54, 75.9%), not industry-funded (45/54, 83.3%), and were early Phase (30/54, 55.6%); there were only three Phase III trials. The relative number of new surgical trial registrations has not changed significantly over time (1990s: 5, 2000s: 19, and 2010s: 30). Approaches integrated with other disciplines, such as image-guided surgery (16/54, 29.6%) and local drug delivery (16/24, 29.6%), were among the leading categories of trials. CONCLUSIONS Despite the clinical role of surgery in management of non-diffusely infiltrating primary CNS tumors, a paucity of innovative surgical trials has been put forth. Multi-disciplinary approaches appear to be necessary for pushing the therapeutic envelope for individuals affected by these tumors, with imaging and drug development at the forefront.

Craniofacial Approaches to Pediatric Orbital Tumors.

Primary pediatric orbital tumors requiring surgery are uncommon and often require multidisciplinary management. Commonly used surgical approaches to the orbit include transconjunctival, transcutaneous (eyelid), transcranial, or extracranial osteotomies. This paper reviews a 10-year experience of cases that required a transcranial or extracranial surgical approach at the Birmingham Children's Hospital. A total of 9 patients were identified between the years 2008 to 2017. Pathologies included rhabdomyosarcoma, juvenile ossifying fibroma, optic nerve glioma, and retinoblastoma. Surgical approaches to the orbit included supraorbital bar osteotomy (transcranial) or lateral orbitotomy (extracranial). Surgical team members included neurosurgery, craniofacial surgery, and ophthalmology. This study aims to review the role of surgery in management as well as the specific indications for performing transcranial or extracranial osteotomies. It also highlights the excellent access achieved with the use of these osteotomies in certain cases, especially when compared with transconjunctival or transcutaneous approaches.

The Role of Surgery in Management of Locally Advanced Non-Small Cell Lung Cancer.

Patients with locally advanced non-small cell lung cancer (NSCLC) are treated for cure, but treatment decisions are not straightforward. Chemotherapy is essential due to the high risk of systemic relapse, but local therapy is also required for cure. In the small subset of stage III patients with N0 or N1 disease, surgery is typically the initial therapy and extended resections are frequent. The majority of IIIA patients present with N2 disease and treatment paradigms for these patients are controversial, particularly concerning the role of resection. Surgery has a limited role in bulky IIIA, IIIB, and IIIC disease, which is typically treated with combined systemic therapy and radiation. The authors believe that in resectable IIIA disease, the addition of surgery to multimodality treatment appears to improve local control and overall survival. Induction therapy is essential, and the use of chemotherapy alone or chemoradiotherapy remains an area of debate. Pneumonectomy should be used with caution in IIIA disease, as numerous prospective trials have noted excessive perioperative mortality. The introduction of immunotherapies in this stage may quickly transform treatment decisions.

The role of surgery in management of tuberculous peritonitis

Background: Tuberculous peritonitis is a serious condition with rising prevalence in recent years. The most common site of involvement is the ileo-caecal region. Treatment with standard antituberculous drugs is usually highly. Surgery is usually reserved for patients who have developed complications, obstruction or not responding to medical management. The aim of this study was to describe the surgical management of tuberculous peritonitis.Methods: This study was carried out at Al-Karama Teaching Hospital between December 2015 to June 2018. A sixty patients with proved tuberculous peritonitis. It was a prospective study in which the records of the patients operated upon as peritonitis or acute intestinal obstruction and whose diagnosis was later confirmed as tuberculosis on histopathology were analysed with regards clinic-pathologic profile, intra-operative findings, surgical intervention performed and outcome in terms of morbidity and mortality.Results: Their age range was between 20-39 years, 25 (62.5%) were females and 15 (37.5) were males, abdominal distension and pallor were a common clinical finding 92.5% and 90% prospectively and 42.5 % of the patients have their complaints for 2-3 months, while history of pulmonary tuberculosis was present in 22.5% of the patients only. In 50% of the patients there were no important findings on chest X-ray. Ascites was positive in 82.5% of patients on abdominal sonography while on diagnostic laparoscopy in 45% of patients the findings were ascites with peritoneal and bowel adhesions.Conclusions: Early diagnosis is the key factor in avoiding systemic and local complications of intestinal tuberculosis. Laparoscopy is the minimal invasive technique for definitive diagnosis with minimal sides effects.

Role of Surgery in Management of Discitis

Background: discitis is an inflammation of the vertebral disc space which may spontaneous or post spinal surgery; that is often diagnosed late. With good response to conservative treatment and in some condition the plan of management is surgical. Aim of the Work: to assess the role of surgery in management of discitis and which approach is appropriate, with comparison between conservative and surgical management and the relationship between risk factors and outcome. Patients and Methods: this prospective and retrospective study was conducted on 25 patients of specific criteria confirmed to have discitis by clinical presentation, radiological findings and laboratory investigations. Results: discitis is more common in old age that occurred in lumbar more that dorsal or cervical disc space with risk factors such as failed spinal surgery (40%), DM (36%), HCV +ve (8%), TB (8%), Brucella (4%) and addiction (4%) of past history with affect the outcome. There was a statistically significant relation between location of discitis and pre modified ranking scale, while modified ranking scale pre and post management were statistically highly significant in each cervical, dorsal and lumbar. Conclusion: both conservative and surgical management have good outcome. But we observed that the risk factors like DM and addiction worsened the prognosis. We also observed that the shorter surgical maneuver the better is the outcome.

Role of surgery in management of liver abscess

Introduction: Liver abscess is a common disease in developing world. Its treatment has evolved in last few years to become less and less invasive. Percutaneous drainage of liver abscess is a wellestablished method and probably most widely accepted as well. However, large and multiloculated abscess containing thick pus may not be suitable for such methods.Methods: All patients with liver abscess, who could not be drained or not found suitable for percutaneous drain insertion and eventually underwent surgery were included in the study.Results: Total 8 patients were treated by surgical drainage, open or laparoscopic technique. Surgical drainage was effective way of treatment for abscesses not treatable by needle aspiration or percutaneous tube drain insertion with good outcome.Conclusion: In patient of liver abscess who has large multiloculated abscess with thick pus or not suitable for percutaneous drainage, surgical treatment either laparoscopic or open can be an effective and successful. Journal of Society of Surgeons of Nepal, 2015; 18 (2), page: 20-22

Role of Surgery in Management of Osteo-Articular Tuberculosis of the Foot and Ankle.

Background:Tuberculosis of the foot and ankle still remains to be a significant problem, especially in the developing countries, and with an increase in incidence in immunosuppressed patients. Treatment is mainly medical using multidrug chemotherapy; surgical interventions range from biopsy, synovectomy and debridement, to joint preserving procedures like distraction in early cases, and arthrodesis of hindfoot joints and the ankle in advanced disease with joint destruction.Surgical Options: All procedures should be done after initiating appropriate medical management. The ankle is the commonest joint needing intervention, followed by the subtalar and talo-navicular joint. Forefoot TB limited to the bone rarely needs surgical intervention except when the infective focus is threatening to invade a joint. Articular disease can spread rapidly, so early diagnosis and treatment can influence the outcome. Surgical interventions may need to be modified in the presence of sinuses and active disease; fusions need compression, and implants have to be chosen wisely. External fixators are the commonest devices used for compression in active disease, but intramedullary nails better stabilize pantalar arthrodesis. Arthroscopy has become a valuable tool for visualizing the ankle and hindfoot joints, and is an excellent adjunct for arthrodesis by minimally invasive methods.Conclusion:Although Osteoarticular Tb involving the foot and ankle is largely managed with chemotherapy, specific indications for surgical intervention exist. Timely done procedures could limit joint destruction, or prevent spread to adjacent joints. Fusions are the commonest procedure for sequelae of disease or for correcting residual deformity.

Tuberculous lymphadenitis of the head and neck in Canadian children: Experience from a low-burden region

BackgroundChildren are more likely than adults to develop extra-pulmonary tuberculosis (EPTB), which often presents as cervical lymphadenopathy. The role of surgery in management is uncertain. We reviewed all head and neck EPTB cases presenting to our tertiary care pediatric institution over a twelve-year period. MethodsAll children 18 years of age and younger with EPTB involving the head and neck were included. We recorded clinical data and age at diagnosis, birth country, BCG vaccination status, as well as radiographic, surgical, histological, and microbiological results. ResultsAll 16 patients presented with cervical lymphadenopathy. Fourteen were born outside of Canada in TB endemic areas and all had foreign-born parents. Diagnosis was confirmed microbiologically from lymph node biopsies in 14 cases. Multi-drug resistant TB was identified in two cases: both had previous excisional node biopsies that had not been cultured. Two patients had culture negative suppuration despite adequate anti-tuberculous treatment that required surgery for cure. ConclusionOngoing suppuration despite appropriate drug therapy is seen in a minority of patients. We found that excisional lymph node biopsy of diseased cervical lymph nodes is diagnostic, and also therapeutic in some cases with ongoing suppuration despite appropriate drug therapy. Mycobacterial culture of lymph nodes is important for diagnosis and determination of drug resistance patterns.

The Role of Surgery in Management of Samter's Triad: A Systematic Review.

Aspirin-exacerbated respiratory disease (AERD) represents a severe form of chronic rhinosinusitis (CRS) characterized by nasal polyposis, bronchial asthma, and aspirin intolerance. This syndrome, known as Samter's triad, is more difficult to manage than routine CRS and poses a challenge to the treating clinician. We performed a systematic review of the literature to determine the role of endoscopic sinus surgery in patients with AERD who are on adjuvant medical therapies. PubMed, Embase, Web of Science, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Cochrane Technology Assessments, Cochrane Economic Evaluations, Cochrane Groups, and Clinicaltrials.gov. A systematic review of the literature was performed using the 2009 PRISMA guidelines. Studies with both preoperative and postoperative data for patients with AERD who underwent sinus surgery were considered appropriate for inclusion. Publications were written in English, included patients aged 18 years or older, and had a minimum follow-up of 3 months. Eighteen studies met criteria for inclusion in our review. The primary outcome was change in symptom profile as measured by sinonasal and asthma symptom scores. Most studies demonstrated improvement in sinus- and asthma-related symptoms and quality-of-life measures after endoscopic sinus surgery. This review, which did not exclude the use of concomitant medical therapy, suggests that surgery is beneficial in AERD management. Evidence demonstrates improvement in sinonasal and asthma symptom severity and frequency, radiographic and endoscopy scores, and quality of life after surgery.

Evaluation of the Role of Endoscopic Endonasal Surgery in Management of Orbital Complications of Rhinosinusitis

The methods for the treatment of orbital complications of rhinosinusitis are often debated: conservative, surgical or combined. Surgical options include both endoscopic and open surgery. However, in the era of endoscopic surgery of the nose and paranasal sinuses, there are still no clear advantages of these techniques over open interventions. Therefore, our study aimed to clarify and evaluate the results of intranasal endoscopic procedures performed in individuals with orbital complications of rhinosinusitis in search for optimal treatment of this group of patients. 30 patients were divided based on Velasco classification into 3 groups; 1st group (14 patients) for patients with orbital cellulitis, 2nd group (10 patients) for patients with subperiosteal orbital abscess and the 3rd one (6 patients) was for patients with intraorbital abscess. Endoscopic endonasal surgery was done for all patients in group II and III and in 4 patients indicated for surgery in group I. Our result showed a highly significant postoperative improvement in proptosis, ocular motility, diplopia and vision acuity. Conclusion: Endoscopic Sinus Surgery offers a convenient, safe, and effective alternative to open procedures and can be successfully performed in well-selected cases of orbital complications of rhinosinusitis with many advantages.

Curative Treatment of Esophageal Cancer; An Evidenced Based Review

In 2013, roughly 18,000 cases of esophageal cancer will be diagnosed in the United States with more than 15,000 people dying from the disease. Worldwide, an estimated 482,300 new esophageal cancer cases were diagnosed with 406,800 deaths in 2008. Squamous cell carcinoma (SCC) and adenocarcinoma (AC) account for >90% of all esophageal cancer cases. The authors will examine the role of radiation therapy, chemotherapy, and surgery in the curative management of esophageal cancer by examining randomized control data, single arm phase II trials, several recently published meta-analyses, as well as retrospective data where there is no clinical trial data available. The role of positron emission tomography (PET) will be reviewed as well. Current data support the role of neoadjuvant chemoradiotherapy followed by surgical resection for locally advanced esophageal cancer with 3-year overall survival ranging from 30% to 60%. The benefit of adjuvant chemoradiation therapy is limited to margin positive and/or node positive patients. There is emerging data questioning the survival benefit of surgical resection after chemoradiotherapy. External beam radiation therapy alone results in very few long-term survivors and is considered palliative at best. Radiation dose-escalation has failed to improve local control or survival. PET scanning is vital in staging and has become a strong predictor of response and survival. Preoperative or definitive concurrent chemoradiotherapy is the established standard of care for locally advanced cancers of the esophagus. While preoperative chemotherapy is supported by level 1 evidence, the true benefit of induction chemotherapy before chemoradiotherapy has not been established in a prospective randomized control trial. The role of surgery in the management of SCC is still a hotly debated subject, however, it is still recommended for AC. There is no data to support adjuvant chemotherapy after preoperative chemoradiotherapy. The benefit of neoadjuvant chemotherapy seems to be limited AC. Radiation without chemotherapy is palliative and never curative. PET continues to be integrated into treatment decisions and predicts for response and survival after therapy.