Neoadjuvant therapy for advanced esophageal cancer: the impact on surgical management

Multidisciplinary therapies have been developed to prolong the survival of patients with resectable esophageal cancer. Worldwide, neoadjuvant therapy has become the standard treatment for locally advanced resectable esophageal cancer. In this article, we briefly review the clinical trials and meta-analyses of neoadjuvant therapy for advanced esophageal cancer. In Europe and the USA, neoadjuvant chemoradiotherapy is regarded as the standard treatment, while neoadjuvant chemotherapy has become the standard treatment in Japan based on the results of clinical trials. Changes in treatment, according to the period and the results of up-to-date studies, are discussed. As neoadjuvant therapy is administered with the assumption that surgery will be performed, it is important for surgeons to be familiar with its impact on surgical management. We also review the impact of neoadjuvant therapy on surgical management. Issues such as the timing of surgery after neoadjuvant therapy, the extent of lymph node dissection, and the operative approach in relation to the esophagus are matters to be elucidated in the future.