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 t he optimal operative treatment. Data from specialized centers indicate that radical esophagectomy with two-field or three-field lymphadenect omy can be performed with low perioperative morbidity and mortality. A lthough such extended lymphadenectomies clearly lead to accurate stagi ng, the therapeutic impact of these procedures is still a matter of de bate. In order to tailor the extent of resection or neoadjuvant therap y to the tumor stage of the individual patient, preoperative staging i s important, Early results on the role of diagnostic laparoscopy and v ideo-assisted thoracoscopy have become available. The interest in perf orming minimally invasive esophagectomies is waning for various reason s, Even extensive surgical therapy has unsatisfactory long-term result s. The majority of patients develop locoregional or:distant tumor recu rrence, Several (neo)adjuvant therapy trials have been performed, but none have proven to be effective. In general, there is a shift in inte rest from adjuvant to neoadjuvant therapy (especially combined chemo- and radiotherapy). Unfortunately, most institutions report nonrandomiz ed phase II trials with a great variety of therapeutic regimens. Moreo ver, interpretation is frequently hampered because the various tumor s tages are poorly defined and because no clear distinction is made betw een squamous cell carcinomas and adenocarcinomas.