Surgery for esophageal cancer

Management of patients with esophageal cancer requires local therapy (surgery or radiation therapy) and systemic therapy, following evidence-based guidelines and stage-specific approaches. Esophagogastrectomy is associated with considerable morbidity and mortality. Various surgical approaches may be used, depending on the disease stage, tumor location, patient-related factors, and surgeon preference. Careful patient selection and preparation, with strict attention to the management of postoperative complications, particularly pneumonia, will optimize patient outcome. There has been a trend toward increased use of induction chemotherapy or chemoradiotherapy, which may confer a modest survival advantage but at the cost of increased treatment-related mortality, particularly in patients receiving induction chemotherapy and radiotherapy. Biomarkers that can predict outcome and help select therapy for patients with esophageal cancer are needed; several potential markers of treatment resistance/sensitivity in patients receiving trimodality therapy with cisplatin/5-fluorouracil, radiation therapy, and surgery have been identified in studies from our laboratory and others.