Surgical and multimodal approaches to cancer of the oesophagus: state of the art

This review article aims to discuss the modalities of oesophageal resection , to define the categories of patients who are most likely to benefit from oesophagectomy with extensive lymph node clearance, and to analyse the even tual contribution of nonsurgical neo-adjuvant or adjuvant therapies to impr oving long-term survival rates achieved by surgery alone. Both the review of the literature devoted to potentially curative treatment of oesophageal cancer and the authors' own experience indicate that resect ion of the oesophageal tube en bloc with the locoregional lymph nodes provi des patients with the best chance of long-term survival and cure. This is t rue, even though some of the resected Lymph nodes are metastatic. Most phas e III comparative studies fail to shown any overall survival improvement fo llowing multimodal therapy in comparison with surgery alone, so that there is now no scientific reason for systematic addition of radio- and/or chemot herapy to extensive surgery in potentially resectable neoplastic processes. However, neo-adjuvant radio- and/or chemotherapy is indicated in suspected non-resectable T4 tumors for downstaging and subsequent oesophageal resect ion in good responders. The benefit in terms of long-term survival and cure that can be expected from adjuvant chemo- and/or radiotherapy after radica l resection of a neoplastic process having already spread into a large numb er of loco-regional lymph node requires objective evaluation by prospective , randomized studies.