Improved Prognosis of Resected Esophageal Cancer.

From Pub Med

Stein HJ, Siewert JR.
Chirurgische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universitat,
Ismaningerstrasse 22, D-81675, Munchen, Germany.

Because of the perceived high risk of esophagectomy and the assumed poor long-term
results, the role of surgical resection as the mainstay of treatment for localized esophageal
cancer is currently being challenged. Early tumors are increasingly approached by
endoscopic mucosectomy or mucosal ablation techniques, whereas combined
radiochemotherapy without surgery has become the treatment of choice for locally advanced
tumors at many institutions. Several recent reports and our experience, however, indicate
that surgical resection of esophageal cancer has become a safe procedure and long-term
survival rates after surgical resection have improved markedly during the past two decades.
A number of factors have been associated with the marked reduction in postoperative
mortality and improved long-term survival after surgical resection. They include changes in
the epidemiology with an increased rate of adenocarcinoma mostly located distally, patient
selection for surgery, improvements in surgical technique and perioperative management,
and the use of neoadjuvant treatment protocols. The treatment strategy and extent of the
surgical procedure can now be tailored based on histologic tumor type, tumor location,
tumor stage, and the general condition of the patient. With an individualized approach,
surgical resection of esophageal cancer can predictably offer cure. Surgical resection thus
remains the major pillar in the successful treatment of esophageal cancer.