[Standard radical esophagectomy in thoracic esophageal cancer]

In Japan, the standard radical surgical procedure in patients with thoracic esophageal cancer is right thoracoabdominal esophagectomy with lymphadenectomy. However, with the development of endoscopic surgery and improvements in chemotherapy and chemoradiotherapy, the role of radical surgery has been changing. The indications for radical surgery are stage I disease without indications for endoscopic resection (endoscopic mucosal resection or endoscopic submucosal dissection), stage II disease, or stage III disease without T 4 tumors. Because of the favorable results of chemoradiotherapy in the treatment of stage I disease, the Japan Clinical Oncology Group (JCOG) started a randomized, controlled trial comparing surgery and chemoradiotherapy in the treatment of stage I thoracic esophageal cancer. The 5-year overall survival rates in patients who underwent surgery alone for thoracic esophageal cancer were 88% with stage I and 52% with stage II + III disease in Japan. The most important area in lymphadenectomy is the region from the neck to superior mediastinum, and three-field dissection is widely performed in Japan. However, there is no evidence that three-field dissection is necessary or that two-field dissection is sufficient. The efficacy of postoperative adjuvant chemotherapy for the treatment of thoracic esophageal cancer was confirmed in a Japanese randomized, controlled trial and it is expected that the timing of adjuvant chemotherapy will change from post- to pre-surgery (neoadjuvant chemotherapy).