[Modern concepts in the surgical treatment of esophageal cancer]

The surgical treatment of esophageal cancer is still one of the most demanding surgical procedures with poor long-term survival and considerable perioperative morbidity and mortality. The McKeown and Ivor Lewis procedures have been described decades ago and are currently mainly applied in multimodal treatment settings. A systematic lymph node dissection is indispensable and prognostically relevant and is adapted to the primary localization of the tumor. The systematic approach to lymph node resection is discussed based on the Japanese classification of the anatomical lymph node location, whereby lymphatic oligometastasis is also specifically addressed. The use of modern techniques has already led to a substantial improvement in the results and the underlying surgical strategies can also be used for laparoscopic, thoracoscopic and robotic procedures. A reduction of perioperative morbidity by the use of minimally invasive procedures is well-established for the abdominal as well as the thoracic phase of the surgery. Innovative visualization systems for assessment of the vascularization or lymphatic drainage ducts and the use of artificial intelligence are expected to further improve safety and oncological precision of surgery for esophageal cancer.