[Therapeutic strategies for advanced respectable esophageal cancer]

There are obvious differences in the clinical characteristics of patients with advanced respectable esophageal cancer between Japan and Western countries. In Japan, more than 90% of patients with esophageal cancer are histologically diagnosed with squamous cell carcinoma. On the other hand, the incidence of esophageal adenocarcinoma is rapidly increasing in the West. As a standard surgical approach, relatively invasive transthoracic extended esophagectomy has been established in Japan since the 1980s and has contributed to improved long-term survival of patients with squamous cell carcinoma. The current standard care for resectable stage II/III esophageal squamous cell carcinoma is neoadjuvant chemotherapy with 5-fluorouracil/cisplatin and radical esophagectomy based on the results of Japan Clinical Oncology Group trial 9907. In the West, relatively less invasive transhiatal esophagectomy with limited lymph node dissection has played a role in the multidisciplinary treatment of esophageal adenocarcinoma. Recently, a multimodal approach to esophageal cancer treatment including definitive chemoradiotherapy has been a focus of attention in both Japan and the West. For the further improvement of long-term survival of patients with esophageal cancer, the optimization of multimodal treatments and establishment of a global standard are essential.