Surgery of esophageal cancer.
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.


CONCLUSIONS
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.
Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Martinistrasse 52, Hamburg, Germany.
F G
FG
Uzunoglu
M
M
Reeh
A
A
Kutup
J R
JR
Izbicki
D000714:Anastomosis, Surgical; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods* / Q000401:mortality; D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D019060:Minimally Invasive Surgical Procedures