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Vol. 31, No. 1, 2013
Issue release date: June 2013
Section title: Esophagus
Dig Dis 2013;31:21-29
(DOI:10.1159/000343650)

Evolution in Surgical Management of Esophageal Cancer

Low D.E.
Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, Seattle, Wash., USA

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Article / Publication Details

First-Page Preview
Abstract of Esophagus

Published online: 6/17/2013

Number of Print Pages: 9
Number of Figures: 0
Number of Tables: 4

ISSN: 0257-2753 (Print)
eISSN: 1421-9875 (Online)

For additional information: http://www.karger.com/DDI

Abstract

Esophageal resection remains the primary treatment for local regional esophageal cancer, although its role in superficial (T1A) cancers and squamous cell cancer is in evolution. Mortality associated with esophagectomy has historically been high but is improving with the current expectation of in-hospital mortality rates of 2-4% in high-volume centers. Most patients with regional cancers (T2-4 N0-3) are recommended for neoadjuvant therapy, which most commonly involves radiochemotherapy. Some centers have proposed treating with definitive chemoradiation and reserving surgery for patients who have persistent or recurrent disease. ‘Salvage resections' are possible but are associated with higher levels of perioperative morbidity and mortality, and treatment decisions should routinely be based on multidisciplinary discussion in the tumor board. Although open surgical resection (both transthoracic and transhiatal operations) remain the most common approach, minimally invasive or hybrid operations are being done in up to 30% of procedures internationally. There are some indications that minimally invasive esophagectomy may decrease the incidence of respiratory complications and decrease length of stay. At this point, oncologic outcomes appear equivalent between open and minimally invasive procedures. Recent reviews from high-volume esophagectomy centers demonstrate that elderly patients can selectively undergo esophagectomy with the expectation of increased complications but similar mortality and survival to younger patients. Multiple studies confirm that quality of life following esophagectomy can be equivalent to the general population when surgery is done in experienced centers. Patients requiring surgical treatment of esophageal cancer should be referred to high-volume centers, especially those with established care pathways or enhanced recovery programs to improve outcomes including morbidity, mortality, survival, and quality of life.


  

Author Contacts

Donald E. Low, MD, FACS, FRCS(c)
Section of General Thoracic Surgery, Virginia Mason Medical Center
1100 Ninth Ave. C6-SUR
Seattle, WA 98111 (USA)
E-Mail gtsdel@vmmc.org

  

Article Information

Published online: June 17, 2013
Number of Print Pages : 9
Number of Figures : 0, Number of Tables : 4, Number of References : 73

  

Publication Details

Digestive Diseases (Clinical Reviews)

Vol. 31, No. 1, Year 2013 (Cover Date: June 2013)

Journal Editor: Malfertheiner P. (Magdeburg)
ISSN: 0257-2753 (Print), eISSN: 1421-9875 (Online)

For additional information: http://www.karger.com/DDI


Article / Publication Details

First-Page Preview
Abstract of Esophagus

Published online: 6/17/2013

Number of Print Pages: 9
Number of Figures: 0
Number of Tables: 4

ISSN: 0257-2753 (Print)
eISSN: 1421-9875 (Online)

For additional information: http://www.karger.com/DDI


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