[Squamous cell carcinoma of the oesophagus--impact of surgery within the therapeutic concept].
Squamous cell carcinomas of the oesophagus are a completely different entity from adenocarcinomas in regard to their aetiopathology, tumour biology, co-morbidity, operative risk, and prognosis. For superficial squamous cell carcinomas, the risk of a relevant lymph node metastatisation already exists from the mucosal infiltration level m3 onward, and thus oncological resection is indicated. Neoadjuvant radiochemotherapy is the international standard for locally advanced squamous cell carcinoma. The early-response should be determined. Non-responders must be identified early, and a salvage operation with a justifiable operative risk should be carried out. Due to its high complete response rate, definitive radiochemotherapy is an option especially for squamous cell carcinomas of the upper third of the oesophagus and for patients with a high operative risk, even though local tumour control is significantly better after surgical therapy. Due to the success of definitive radiochemotherapy, the question is being asked increasingly, whether surgical resection after neoadjuvant radiochemotherapy will still be necessary in the future or whether radiochemotherapy alone can attain similar results for relapse-free survival and total survival. Surgical therapy should always be carried out in a specialised high volume centre with low morbidity and mortality. Future research will focus on predictors of the histopathological response, in order to possibly more accurately avoid surgical morbidity in patients with complete pathological responses after multimodal therapy.
Gockel
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I
Klinik für Allgemein- und Abdominalchirurgie, Johannes-Gutenberg-Universität, Mainz. gockel@ach.klinik.uni-mainz.de
Lang
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H
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D016629:Esophagectomy; D004945:Esophagoscopy; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant