Surgery for upper gastrointestinal malignancies

The incidence, diagnostic modalities, and therapeutic options for gastric and esophageal cancers have undergone important changes in the last decades. Distal gastric cancers are seen less often compared to proximal tumors. Early detection and improved perioperative care have increased their resectability. Partial stomach resection with a proper albeit nonradical lymph node dissection seems adequate treatment, and adjuvant treatment is not required for most patients. Tumors located in and around the gastroesophageal junction have become the most frequently seen upper gastrointestinal malignancies. Their anatomical relations and their early tendency to spread to thoracic and abdominal lymph nodes make these tumors among the most difficult to treat. The value and extent of surgery and the impact of additional (neo-)adjuvant therapy are less clear. It seems beneficial to treat these patients in high-volume centers and it is mandatory to increase the number of patients included in multimodality therapy trials.