The best surgical treatment strategy for esophageal cancer based on clinical trials / 中华消化外科杂志

ABSTRACT

Curative esophagectomy and radical lymphadenectomy are the keys to reducing postoperative recurrence and metastasis, improving long-term survival of patient. With the impro-vement of surgical techniques, open, minimally invasive and robotic esophagectomy could be performed safely. For middle and lower esophageal squamous cell carcinoma, radical thoracic-abdominal two-field lymphadenectomy in the upper mediastinum is needed. However, multidisciplinary treatment involving surgery, radiotherapy and chemotherapy is necessary for locally advanced esophageal cancer. Based on the clinical trials for esophageal adenocarcinoma, scholars from European and American believe that compared to surgery alone, neoadjuvant radiotherapy and chemotherapy can improve the survival of patients. According to the results of JCOG1109 research, scholars from Japan suggest that the DCF protocol (docetaxel, cisplatin and 5-fluorouracil) could be the standard as neoadjuvant chemotherapy for esophageal squamous cell carcinoma. Regarding to postoperative adjuvant therapy, immunotherapy can improve survival for those with residual disease after neo-adjuvant chemoradiotherapy. For neoadjuvant therapy, the safety and efficacy of immunotherapy have also been proved. The authors review the clinical trials referring to surgical treatment including surgical approaches, extent of lymphadenectomy and multidisciplinary treatment, aiming to offer indications for the future best surgical treatment strategy for esophageal cancer.