Surgical Treatment for Esophageal Cancer

Abstract

Esophageal cancer is one of the most difficult malignancies to cure. The prognosis remains unsatisfactory despite significant advances in surgical techniques and perioperative management. The optimal treatment strategy for localized esophageal cancer has not yet been established. Surgical resection remains the mainstay of treatment for esophageal cancer, and curative resection is the most important surgery. Extended esophagectomy with three-field lymphadenectomy provides the highest quality of tumor clearance and prolongation of patient survival. There has been intense effort in developing novel strategies to treat patients with resectable esophageal cancer. Various combined-modality approaches have been attempted to improve treatment outcomes. Definitive chemoradiotherapy has an impact on long-term survival in patients with resectable esophageal cancer. Accordingly, there are three main combined-modality approaches: esophagectomy with adjuvant chemotherapy or chemoradiotherapy; primary definitive chemoradiotherapy with or without salvage esophagectomy, and preoperative chemoradiotherapy followed by planned esophagectomy. Recently, owing to the remarkable advances in optical technology, minimally invasive esophagectomy using endoscopic instruments has been introduced into esophageal cancer surgery. This article reviews recent changes in the treatment of esophageal cancer surgery, and considers the role of esophagectomy.

The clinical application of 18F‐fluorodeoxyglucose positron emission tomography to predict survival in patients with operable esophageal cancer

“…This may be because the number of pathologically positive lymph nodes is an independent prognostic factor in esophageal cancer. 1,37 This clinical reality may be consistent with the clinical value of baseline PET in patients with operable esophageal cancer. In this study, all patients with >3 PET-positive lymph nodes had >5 histologically positive lymph nodes, highlighting that there is a distinct possibility that patients with PET-positive lymph nodes already have multiple histologically positive lymph nodes.…”

“…1,2 Accurate tumor staging, particularly with regard to the depth of tumor invasion, involvement of lymph nodes, and distant metastasis, is essential for optimal treatment selection and delivery, facilitating individually tailored patient management. 1 The role and potential value of 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) as a noninvasive imaging modality in the management of esophageal cancer has been widely investigated over the past decade.…”

“…1,2 Accurate tumor staging, particularly with regard to the depth of tumor invasion, involvement of lymph nodes, and distant metastasis, is essential for optimal treatment selection and delivery, facilitating individually tailored patient management. 1 The role and potential value of 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) as a noninvasive imaging modality in the management of esophageal cancer has been widely investigated over the past decade. [3][4][5][6][7][8][9][10][11][12][13][14][15] FDG-PET imaging may facilitate diagnosis in patients with malignant diseases by enabling the differentiation between benign and malignant tumors, assessment of the extension of disease, [3][4][5][6][7][8][9][10][11] detection of tumor recurrence [12][13][14] and monitoring responses to therapy.…”

The Efficacy of FDG-PET for the Management of Esophageal Cancer: Review Article

“…1,2) Accurate tumor staging-particularly with regard to the depth of tumor invasion, involvement of lymph nodes, and distant metastasis-is essential for optimal treatment selection and delivery. It facilitates individually tailored patient management.…”

“…It facilitates individually tailored patient management. 1) Preoperative chemotherapy and chemoradiotherapy have been introduced as therapeutic options for locally advanced cancer to downsize the primary tumor. This step increases the rate of complete resection, which improves local tumor control and prevents the formation of distant metastases.…”