Surgical Treatment for Esophageal CancerMasayuki Watanabe, Yoshifumi Baba, Naoya Yoshida and Hideo Baba*
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan
- Corresponding Author:
- Hideo Baba, M.D., Ph.D
FACS., Department of Gastroenterological Surgery
Graduate School of Medical Sciences
Kumamoto University, Chuo-ku
Kumamoto 860-8556, Japan
Fax: 81- 96-371-4378
E-mail: [email protected]
Received Date: April 19, 2012; Accepted Date: May 19, 2012; Published Date: May 22, 2012
Citation:Watanabe M, Baba Y, Yoshida N, Baba H (2012) Surgical Treatment for Esophageal Cancer. J Nucl Med Radiat Ther S2:004. doi:10.4172/2155-9619.S2-004
Copyright: © 2012 Watanabe M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Esophagectomy is the main treatment for esophageal cancer. The 2 histologic subtypes of esophageal cancer are squamous cell carcinoma and adenocarcinoma; these subtypes have different biologic features and treatment strategies. Although the prognosis of patients treated with surgery alone remains unsatisfactory, neoadjuvant therapy helps to improve outcome. A meta-analysis revealed that neoadjuvant chemoradiotherapy provides survival benefits for both histologic types, while neoadjuvant chemotherapy is useful for adenocarcinoma. In Western countries, neoadjuvant chemoradiotherapy is a standard treatment for resectable advanced esophageal cancer, while neoadjuvant chemotherapy has become the standard treatment in Japan. Esophagectomy can be performed by several different approaches, including McKeown (cervico-thoraco-abdominal), Ivor-Lewis (thoraco-abdominal), and transhiatal approaches. It has been suggested that Minimally Invasive Esophagectomy (MIE) contributes to the reduction of pulmonary complications. Cervico-thoraco-abdominal 3-field lymphadenectomy may prolong survival, but a randomized control study on this subject has not been conducted. Mortality and morbidity rates after esophagectomy remain high. Several meta-analyses demonstrated that esophagectomy at low-volume hospitals was associated with a significant increase in the incidence of in-hospital and 30-day mortality. The influence of hospital volume on long-term outcome continues to be a subject of debate.
In conclusion, surgical resection remains the main treatment for potentially curable esophageal cancer. Neoadjuvant treatment can improve long-term outcome after esophagectomy. Furthermore, MIE may improve shortterm outcome, and 3-field lymph node dissection may reduce the risk of recurrence. The effects of these surgical procedures should be confirmed by randomized prospective studies.