[Esophageal carcinoma: surgical treatment concepts; access and resectability]

The resectability of oesophageal cancer depends very much on the tumour's localisation and extent. Maintenance of a proximal safety margin of at least 5 cm, and closeness to the posterior tracheal wall, only rarely allow primary resection of high thoracic or intracervical oesophageal cancer above the bifurcation. A possible alternative in this situation is combined radiochemotherapy. If the tumour responds to this therapy and there are no distant metastases, secondary resection frequently remains possible. On the other hand, in the distal oesophagus below the tracheal bifurcation, without involvement of the bronchial system, primary resection is often possible, and in this case infiltrated contiguous structures such as the pericardium and the crura of the diaphragm can also be resected. The extent of the lymphadenectomy is controversial at present. However, as part of an en bloc resection it should today include at least complete dissection of the posterior mediastinum and the upper abdomen (2-field lymphadenectomy). Additional cervical lymphadenectomy (3-field lymphadenectomy) can be recommended in high intrathoracic and cervical oesophageal cancer despite high morbidity, since this reduces the rate of loco-regional recurrences and thus improves the long-term prognosis. Mortality following oesophageal resection probably ranges around 5% today. Postoperative morbidity remains relatively high at over 50%. A reduction in morbidity demands not only competent surgical management and intensive care, but also, in particular, improved selection of patients and their specific preoperative preparation.