Status of surgical trials in clinical oncology, part 1

Advances in surgery, anesthesiology and in critical care remarkably elevate d safety of surgical therapy of cancer. However, prognosis of most cancer t ypes as esophageal and gastric carcinoma - as discussed in this part of the survey - did not improve, even not after adjuvant therapy. To enhance cura tive resection rate chemotherapy and radiation or a combination of both hav e been performed preoperatively. The weakness of radiotherapy is control of distant metastases, chemotherapy failed in local tumor control. Multimodal preoperative strategies offered enhanced survival in responders, but overa ll there was no significant survival advantage. Until now neither in esopha geal nor in gastric cancer randomised studies could demonstrate a substanti al overall survival benefit after extended lymphadenectomy.