[Esophageal carcinoma: guidelines in surgical therapy]

According to oncological criteria, resections for esophageal cancer require a combined abdominal and thoracic approach and should include two-field lymphadenectomy. The value of a three-field lymphadenectomy is still under discussion, because this extended lymph node dissection may provide better survival rates for patients with proximal esophageal cancer and positive lymph node stages on the one hand, but will cause increased morbidity, on the other. A neoadjuvant radio- and/or chemotherapy allows down staging in about 50% of patients with advanced esophageal cancer (stage IIB, III or IV). This leads to higher resectability rates, but is not necessarily associated with better survival rates.