Current surgical research addresses the optimal approach to potentiall
y curative resection. Several retrospective studies indicate that the
transhiatal procedure is technically safe. It is still unclear, howeve
r, whether long-term survival can be improved by using more extensive,
transthoracic procedures, including two-regional or three-regional ly
mph node dissection. Minimally invasive techniques have been described
with impressive preliminary results both for preoperative staging and
for operative resection of esophageal cancer. For locally irresectabl
e tumors, effective palliation can be achieved with combined intralumi
nal and external radiotherapy. A slight improvement in local control i
s achieved by addition of intraluminal radiotherapy to conventional ex
ternal radiotherapy, but long-term survival is poor. if life expectanc
y is short, single intraluminal radiotherapy can offer effective relie
f of dysphagia. As of yet, no data are available comparing this approa
ch with pertubation. Finally, the efficacy of multimodality treatment
to improve long-term surgical results has been extensively investigate
d. After neoadjuvant chemotherapy and/or radiotherapy, pathologically
complete remission rates vary widely in several retrospective studies.
Sterile surgical specimens seem to be associated with better survival
results, although patients with microscopical residual disease may ha
ve long-term survival. In conclusion, the data on combined approaches
are promising, but more randomized studies are needed to establish the
ir exact role in the treatment of esophageal carcinoma.