Individualised surgical treatment of patients with an adenocarcinoma of the distal oesophagus or gastro-oesophageal junction.
In this review we discuss the different strategies to improve surgical outcomes after potentially curative resection for oesophageal adenocarcinoma. For tumours of the distal oesophagus, there is a 17% survival benefit after transthoracic resection with two-field lymph node dissection when compared with transhiatal resection. This survival benefit is absent for tumours of the gastro-oesophageal junction or gastric cardia. These patients should, in the absence of tumour-positive lymph nodes at or proximal to the carina, undergo a transhiatal resection to minimise peri-operative complications. New developments include endoscopic resection or minimally invasive oesophagectomy, but these therapies should still be considered experimental.
Hulscher
J B F
JB
Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
van Lanschot
J J B
JJ
D000230:Adenocarcinoma / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004943:Esophagogastric Junction / Q000601:surgery*; D006801:Humans; D016019:Survival Analysis; D016896:Treatment Outcome