Surgery of esophageal cancer
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REVIEW ARTICLE
Surgery of esophageal cancer F. G. Uzunoglu & M. Reeh & A. Kutup & J. R Izbicki
Received: 2 January 2013 / Accepted: 14 January 2013 / Published online: 25 January 2013 # Springer-Verlag Berlin Heidelberg 2013
Abstract Background Surgery is the only option for curative treatment in patients with esophageal carcinoma. Despite the debates related to the peri-operative therapy regime, a generally accepted consensus on surgical approach is not reached yet. The debate focuses mainly on pros and cons between radical transthoracic resection and the (limited) transhiatal resection in the last decade. Methods The PubMed database was searched for randomized trials, meta-analyses, and retrospective single-center studies. The search terms were “esophageal carcinoma,” “esophageal junction carcinomas,” “transhiatal,” “transthoracic,” “morbidity,” “mortality,” and “surgery.” Results The radical transthoracic approach should be the standard of care for esophageal carcinoma since it does not go along with an increased risk of postoperative morbidity or mortality but reveals an improved survival. Patientrelated co-morbidities are the most influencing factors for the postoperative outcome. For type II esophageal junction carcinoma, treatment options from transhiatal extended gastrectomy to esophagectomy with hemigastrectomy or esophagogastrectomy with colonic interposition are existing. In type III esophagogastric junction carcinomas, the transhiatal extended gastrectomy is the standard of care, and the minimally invasive approach should be performed in specialized centers. Conclusion Based on current available study results, this expert review provides a decision support for the best surgical strategy depending on tumor localization and patients’ characteristics. F. G. Uzunoglu : M. Reeh : A. Kutup : J. R. Izbicki (*) Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany e-mail: [email protected]
Keywords Esophageal cancer . Morbidity . Mortality . Surgery . Transhiatal . Transthoracic
Introduction The outcome of patients with esophageal carcinoma depends on numerous clinical and pathological variables and might be influenced by different surgical approaches. A worldwide-established consensus on therapeutic pathways is still missing. Debate exists on whether neoadjuvant and adjuvant treatment regimes improve the prognosis and which surgical approach reaches an optimal balance between radical resection, postoperative outcome, and survival. The first two contentious points are already discussed elsewhere [1]. Thus far, it is difficult to assess a reliable contribution of neoadjuvant treatment modalities since numerous studies have been carried out with inconsistent patient’s groups, different surgical procedures, and incomplete pathological and preoperative staging results. This article focuses on the surgical approach which is the only option for curative treatment in patients with esophageal carcinoma [2]. The major discourse on surgical
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