Esophageal cancer surgery in 2005

Surgery for esophageal cancer remains a cornerstone for early stage disease. The treatment of more advanced locoregional disease is quite controversial. Efforts to improve survival in more advanced stages include using chemoradiotherapy alone without operation, using induction or adjuvant therapy in conjunction with resection, and performing a more radical resection by an en-bloc approach and/or a three-field lymph node dissection. The actual approach to esophagectomy in an individual patient is very controversial and seems to be mostly surgeon and institution dependent. There is a paucity of large, adequately powered randomized clinical trials to guide surgical care of patients with esophageal cancer. Accordingly, the numerous aspects of care of the patient are quite varied with little consensus reached among surgeons. There is increasing evidence that the care of the patient requiring an esophagectomy be performed in an institution and by a surgeon with a relatively high volume.