Current strategy in surgery for esophageal cancer

Curative surgical treatment of esophageal cancer involves the complete macroscopic and microscopic removal of the tumor (R0-resection). Only by these means the prognosis can be improved. The treatment of choice for squamous cell cancer is transthoracic en-bloc esophagectomy. Preoperative risk analysis of the patient and staging of the tumor especially by endoscopic ultrasonography are mandatory. Tumors penetrating the esophageal wall (T3, T4) above the tracheal bifurcation and T4-tumors below the bifurcation should be treated preoperatively by (radio-)chemotherapy within the framework of a multimodal therapeutic approach.