Surgical Factors Influencing Outcomes in Patients Resected for Cancer of the Esophagus or Gastric Cardia
Because of the perceived high risk of esophagectomy and the assumed poor long-term results, the role of surgical resection as the mainstay of treatment for localized esophageal cancer is currently being challenged. Early tumors are increasingly approached by endoscopic mucosectomy or mucosal ablation techniques, whereas combined radiochemotherapy without surgery has become the treatment of choice for locally advanced tumors at many institutions. Several recent reports and our experience, however, indicate that surgical resection of esophageal cancer has become a safe procedure and long-term survival rates after surgical resection have improved markedly during the past two decades. A number of factors have been associated with the marked reduction in postoperative mortality and improved long-term survival after surgical resection. They include changes in the epidemiology with an increased rate of adenocarcinoma mostly located distally, patient selection for surgery, improvements in surgical technique and perioperative management, and the use of neoadjuvant treatment protocols. The treatment strategy and extent of the surgical procedure can now be tailored based on histologic tumor type, tumor location, tumor stage, and the general condition of the patient. With an individualized approach, surgical resection of esophageal cancer can predictably offer cure. Surgical resection thus remains the major pillar in the successful treatment of esophageal cancer.