Journal of Surgery

Current Surgical Treatment of Esophageal Cancer-Distal Adenocarcinoma, Multidisciplinary Approach, Evolving Minimal-Invasive Approach at High-Volume Centers

Abstract

Ulrich Klaus Fetzner*, Pinghai Hu, Hesham Ahmed Gamaleldeen Elwan, Ahmed Milad Mohamed El Meghrawi, Christian Maret, Mathias Stefan Silvester Loehnert and Peter Philipp Grimminger

Even in 2020 esophageal cancer stays a severe disease and means a caesura in the life of the affected.

Early carcinoma under strict indications and conditions can be safely resected by interventional endoscopy. In locally advanced esophageal cancer of the mid and lower third radical resection stays the gold-standard. The favored approach is the transthoracic esophagectomy with 2-field lymphadenectomy and reconstruction by gastric pullup. In recent years, progress resulted in a notable decrease in morbidity and mortality of these procedures and in an acceptable life quality despite resection and reconstruction.

Additionally, multidisciplinary treatment-especially neoadjuvant chemo- and radiochemotherapy-improved long-term survival. Overall it is clear, that the treatment of esophageal cancer in high volume centers is safer and more effective.

Challenges for the future are the further development of minimally invasive procedures by laparoscopic, thoracoscopic, or robot-assisted approaches, which results in minimizing the operative trauma and reducing pulmonary complications.

With further progress in decoding the esophageal cancer gene, gene-products, and pathways more specific prevention and more targeted therapy could be applied.

Standards of treatment of esophageal cancer differ from country to country. This lies mostly in the ethnic differences like incidence, the unequal distribution of squamous cell carcinoma and adenocarcinoma, and in broad differences in concepts and the capability of the health systems. This review focuses on the current surgical diagnostic and curative treatment of esophageal cancer at the majority of high volume centers in Germany by reviewing the associated literature and imbedded by the author's own clinical and academic experiences.

PDF