[Non-metastasized oesophageal cancer]

Recently the incidence of oesophageal carcinoma has increased predominantly due to a rise in the incidence of adenocarcinoma. A relationship with the increasing prevalence of Barrett's oesophagus plays an important role. Diagnosis and staging should include oesophago-gastro-duodenoscopy, transoesophageal endo-echography and computer tomography. A higher sensitivity and specificity for distant metastases may possibly be achieved by adding positron emission tomography. In patients with adenocarcinoma neoadjuvant chemoradiotherapy followed by surgery has been associated with better survival. This effect is less convincing in squamous cell carcinomas. Distal and gastro-oesophageal tumours are particularly suitable for a transhiatal approach. Intrathoracic tumours are suitable for a transthoracic resection. There is no difference in survival after the transhiatal or the transthoracic approach, despite the less extensive lymph node dissection in the transhiatal procedure. Minimally invasive oesophagectomy seems to be associated with a lower morbidity and a shorter hospital stay. Randomized trials are needed to substantiate these results.