Top

Langenbeck's Archives of Surgery

Published in:

01-02-2013 | Review Article

Surgery of esophageal cancer

Authors: F. G. Uzunoglu, M. Reeh, A. Kutup, J. R Izbicki

Published in: Langenbeck's Archives of Surgery | Issue 2/2013

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. Patient-related 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.

Lordick F, Holscher AH, Haustermans K, Wittekind C (2012) Multimodal treatment of esophageal cancer. Langenbecks Arch Surg. doi:10.1007/s00423-012-1001-1

Mariette C, Piessen G, Triboulet JP (2007) Therapeutic strategies in oesophageal carcinoma: role of surgery and other modalities. Lancet Oncol 8:545–553PubMedCrossRef

Reeh M, Nentwich MF, von Loga K, Schade J, Uzunoglu FG, Koenig AM et al (2012) An attempt at validation of the seventh edition of the classification by the International Union Against Cancer for esophageal carcinoma. Ann Thorac Surg 93:890–896PubMedCrossRef

Sobin LH, Gospodarowicz MK, Wittekind C (2010) International Union against Cancer. TNM classification of malignant tumours. 7th ed. Wiley, Chichester

Nishihira T, Hirayama K, Mori S (1998) A prospective randomized trial of extended cervical and superior mediastinal lymphadenectomy for carcinoma of the thoracic esophagus. Am J Surg 175:47–51PubMedCrossRef

Yajima S, Oshima Y, Shimada H (2012) Neck dissection for thoracic esophageal squamous cell carcinoma. Int J Surg Oncol 2012:750456PubMed

Ott K, Lordick F, Molls M, Bartels H, Biemer E, Siewert JR (2009) Limited resection and free jejunal graft interposition for squamous cell carcinoma of the cervical oesophagus. Br J Surg 96:258–266PubMedCrossRef

Klink CD, Binnebosel M, Otto J, Boehm G, von Trotha KT, Hilgers RD et al (2012) Intrathoracic versus cervical anastomosis after resection of esophageal cancer: a matched pair analysis of 72 patients in a single center study. World J Surg Oncol 10:159PubMedCrossRef

Okuyama M, Motoyama S, Suzuki H, Saito R, Maruyama K, Ogawa J (2007) Hand-sewn cervical anastomosis versus stapled intrathoracic anastomosis after esophagectomy for middle or lower thoracic esophageal cancer: a prospective randomized controlled study. Surg Today 37:947–952PubMedCrossRef

10.

Nederlof N, Tilanus HW, Tran TC, Hop WC, Wijnhoven BP, de Jonge J (2011) End-to-end versus end-to-side esophagogastrostomy after esophageal cancer resection: a prospective randomized study. Ann Surg 254:226–233PubMedCrossRef

11.

Kim RH, Takabe K (2010) Methods of esophagogastric anastomoses following esophagectomy for cancer: a systematic review. J Surg Oncol 101:527–533PubMedCrossRef

12.

Bird P, Daniel F, MacLellan D (1996) Oesophagogastrectomy with an anastomosis using linear staplers. Aust N Z J Surg 66:757–763PubMedCrossRef

13.

Behrenbruch C, Kalogeropoulos G, Cade R (2012) The hybrid intrathoracic oesophago-gastric anastomosis in oesophageal cancer-morbidity and mortality: the hybrid intrathoracic oesophagogastric anastomosis. J Gastrointest Surg. doi:10.1007/s11605-012-2078-0

14.

van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP et al (2012) Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366:2074–2084PubMedCrossRef

15.

Schroder W, Vallbohmer D, Bludau M, Banczyk A, Gutschow C, Holscher AH (2008) The resection of the azygos vein—necessary or redundant extension of transthoracic esophagectomy? J Gastrointest Surg 12:1163–1167PubMedCrossRef

16.

Bogoevski D, Bockhorn M, Koenig A, Reeh M, von Loga K, Sauter G et al (2011) How radical should surgery be for early esophageal cancer? World J Surg 35:1311–1320PubMedCrossRef

17.

Altorki NK, Zhou XK, Stiles B, Port JL, Paul S, Lee PC et al (2008) Total number of resected lymph nodes predicts survival in esophageal cancer. Ann Surg 248:221–226PubMedCrossRef

18.

Horstmann O, Verreet PR, Becker H, Ohmann C, Roher HD (1995) Transhiatal oesophagectomy compared with transthoracic resection and systematic lymphadenectomy for the treatment of oesophageal cancer. Eur J Surg 161:557–567PubMed

19.

Peyre CG, Hagen JA, DeMeester SR, Altorki NK, Ancona E, Griffin SM et al (2008) The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg 248:549–556PubMedCrossRef

20.

Yekebas EF, Schurr PG, Kaifi JT, Link BC, Kutup A, Mann O et al (2006) Effectiveness of radical en-bloc-esophagectomy compared to transhiatal esophagectomy in squamous cell cancer of the esophagus is influenced by nodal micrometastases. J Surg Oncol 93:541–549PubMedCrossRef

21.

Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P et al (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347:1662–1669PubMedCrossRef

22.

Omloo JM, Lagarde SM, Hulscher JB, Reitsma JB, Fockens P, van Dekken H et al (2007) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg 246:992–1000, discussion 1000–1001PubMedCrossRef

23.

Kutup A, Link BC, Schurr PG, Strate T, Kaifi JT, Bubenheim M et al (2007) Quality control of endoscopic ultrasound in preoperative staging of esophageal cancer. Endoscopy 39:715–719PubMedCrossRef

24.

Merkow RP, Bilimoria KY, McCarter MD, Phillips JD, Decamp MM, Sherman KL et al (2012) Short-term outcomes after esophagectomy at 164 American College of Surgeons National Surgical Quality Improvement Program Hospitals: effect of operative approach and hospital-level variation. Arch Surg 147:1009–1016PubMedCrossRef

25.

Chandrasoma P, Makarewicz K, Wickramasinghe K, Ma Y, Demeester T (2006) A proposal for a new validated histological definition of the gastroesophageal junction. Hum Pathol 37:40–47PubMedCrossRef

26.

Chandrasoma P, Wickramasinghe K, Ma Y, DeMeester T (2007) Adenocarcinomas of the distal esophagus and "gastric cardia" are predominantly esophageal carcinomas. Am J Surg Pathol 31:569–575PubMedCrossRef

27.

Reeh M, Mina S, Bockhorn M, Kutup A, Nentwich MF, Marx A et al (2012) Staging and outcome depending on surgical treatment in adenocarcinomas of the oesophagogastric junction. Br J Surg 99:1406–1414PubMedCrossRef

28.

Schurr PG, Yekebas EF, Kaifi JT, Lasch S, Strate T, Kutup A et al (2006) Lymphatic spread and microinvolvement in adenocarcinoma of the esophago-gastric junction. J Surg Oncol 94:307–315PubMedCrossRef

29.

von Rahden BH, Stein HJ, Siewert JR (2006) Surgical management of esophagogastric junction tumors. World J Gastroenterol 12:6608–6613

30.

Siewert JR, Feith M, Stein HJ (2005) Biologic and clinical variations of adenocarcinoma at the esophago-gastric junction: relevance of a topographic-anatomic subclassification. J Surg Oncol 90:139–146, discussion 146PubMedCrossRef

31.

Ellis FH Jr, Heatley GJ, Krasna MJ, Williamson WA, Balogh K (1997) Esophagogastrectomy for carcinoma of the esophagus and cardia: a comparison of findings and results after standard resection in three consecutive eight-year intervals with improved staging criteria. J Thorac Cardiovasc Surg 113:836–846, discussion 846–838PubMedCrossRef

32.

Hagen JA, Peters JH, DeMeester TR (1993) Superiority of extended en bloc esophagogastrectomy for carcinoma of the lower esophagus and cardia. J Thorac Cardiovasc Surg 106:850–858, discussion 858–859PubMed

33.

Sasako M, Sano T, Yamamoto S, Sairenji M, Arai K, Kinoshita T et al (2006) Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol 7:644–651PubMedCrossRef

34.

Luketich JD, Pennathur A, Awais O, Levy RM, Keeley S, Shende M et al (2012) Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg 256:95–103PubMedCrossRef

35.

Holscher AH, Fetzner UK (2012) Modern diagnostics and stage-oriented surgery: therapy of adenocarcinoma of the esophagogastric junction. Chirurg 83:702–708–710–711

Title: Surgery of esophageal cancer
Authors: F. G. Uzunoglu
M. Reeh
A. Kutup
J. R Izbicki
Publication date: 01-02-2013
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 2/2013
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-013-1052-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surgery of esophageal cancer

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2013

Preoperative therapy of esophagogastric cancer: the problem of nonresponding patients

Clinical practice guidelines (CPGs) reduce costs in the management of isolated splenic injuries at pediatric trauma centers

Risk factors for permanent stoma after low anterior resection for rectal cancer

Perioperative blood pressure alterations after eversion and conventional carotid endarterectomy sustain in the midterm

Combined resection of colorectal hepatic–pulmonary metastases shows improved outcome over chemotherapy alone

Subsequent gene expression pattern in dendritic cells following multiple trauma