Rationale for Type of Resection in Cancer of the Esophagus and Gastroesophageal Junction

  • Wolfram T. Knoefel
  • Ingo Alldinger
  • Jakob R. Izbicki


Despite new insights into its molecular basis and various treatment options evaluated in numerous trials, therapy of esophageal cancer remains a challenge. In the past, surgery was the only treatment option. A patient qualified for surgery when he presented in stable condition and when the tumor was believed to be resectable. Today a vast number of treatment strategies, including induction chemotherapy, radiochemotherapy with or without combination with surgery, administered in an adjuvant or a neoadjuvant setting, are added to the traditional therapy of surgery alone. Even the question, whether surgery after effective chemoradiation does have any impact on prognosis at all or is no more than a “big biopsy” is discussed today. There is increasing evidence that patients may benefit from induction chemotherapy.


Esophageal Cancer Esophageal Carcinoma Gastroesophageal Junction Oesophageal Cancer Celiac Trunk 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Munro AJ (2004) Oesophageal cancer: a view over overviews. Lancet 364:566–568PubMedCrossRefGoogle Scholar
  2. 2.
    Bedenne L, Michel P, Bouche O et al (2002) Randomized phase III trial in locally advanced esophageal cancer: radiochemotherapy followed by surgery versus radiochemotherapy alone (FFCD 9102). Am Soc Clin Oncol Proc, p 519 (abstract)Google Scholar
  3. 3.
    Medical Research Council Oesophageal Cancer Working Group (2002) Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet 359:1727–1733CrossRefGoogle Scholar
  4. 4.
    Stein HJ, Feith M, Müller J, Werner M, Siewert JR (2000) Limited resection for early adenocarcinoma in Barrett’s esophagus. Ann Surg 232(6):733–742PubMedCrossRefGoogle Scholar
  5. 5.
    Beatty JD, DeBoer G, Rider WD (1979) Carcinoma of the esophagus: pretreatment assessment, correlation of radiation treatment parameters with survival, and identification and management of radiation treatment failure. Cancer 43:2254–2267PubMedCrossRefGoogle Scholar
  6. 6.
    Earlam R, Cunha-Melo JR (1980) Oesophageal squamous cell carcinoma: I. A critical review of surgery. Br J Surgery 67:381–390CrossRefGoogle Scholar
  7. 7.
    Newaishy GA, Read GA, Duncan W, Kerr GR (1982) Results of radical radiotherapy of squamous cell carcinoma of the oesophagus. Clin Radiol 33: 347–352PubMedCrossRefGoogle Scholar
  8. 8.
    Lund O, Hasenkam JM, Aagaard MT, Kimose HH (1989) Time-related changes in characteristics of prognostic significance in carcinomas of the oesophagus and cardia. Br J Surg 76:1301–1307PubMedCrossRefGoogle Scholar
  9. 9.
    Blot WJ, Devesa SS, Kneller RW, Fraumeni JF Jr (1991) Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 265:1287–1289PubMedCrossRefGoogle Scholar
  10. 10.
    Akiyama H (1980) Surgery for carcinoma of the esophagus. Curr Probl Surg 17:53–120PubMedCrossRefGoogle Scholar
  11. 11.
    Baba M, Aikou T, Yoshinaka H, Natsugoe S, Fukumoto T, Shimazu H, Akazawa K (1994) Long-term results of subtotal esophagectomy with three-field lymphadenectomy for carcinoma of the thoracic esophagus. Ann Surg 219:310–316PubMedCrossRefGoogle Scholar
  12. 12.
    Hennessy TP (1994) Lymph node dissection. World J Surg 18:367–372PubMedCrossRefGoogle Scholar
  13. 13.
    Lerut TE, de Leyn P, Coosemans W, Van Raemdonck D, Cuypers P, Van Cleynenbreughel B (1994) Advanced esophageal carcinoma. World J Surg 18:379–387PubMedCrossRefGoogle Scholar
  14. 14.
    Akiyama H, Tsurumaru M, Udagawa H, Kajiyama Y (1994) Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg 220:364–373PubMedCrossRefGoogle Scholar
  15. 15.
    Fujita H, Kakegawa T, Yamana H, Shima I, Toh Y, Tomita Y, Fujii T, Yamasaki K, Higaki K, Noake T et al (1995) Mortality and morbidity rates, postoperative course, quality of life, and prognosis after extended radical lymphadenectomy for esophageal cancer. Comparison of three-field lymphadenectomy with two-field lymphadenectomy. Ann Surg 222:654–662PubMedCrossRefGoogle Scholar
  16. 16.
    Kato H, Tachimori Y, Watanabe H, Igaki H, Nakanishi Y, Ochiai A (1996) Recurrent esophageal carcinoma after esophagectomy with three-field lymph node dissection. J Surg Oncol 61:267–272PubMedCrossRefGoogle Scholar
  17. 17.
    Altorki NK, Skinner DB (1997) Occult cervical nodal metastasis in esophageal cancer: preliminary results of three-field lymphadenectomy. J Thorac Cardiovasc Surg 113:540–544PubMedCrossRefGoogle Scholar
  18. 18.
    Lerut T, Nafteux P, Moons J, Coosemans W, Decker G, De Leyn P, Van Raemdonck D, Ectors N (2004) Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 R0 resections: impact on staging, disease-free survival, and outcome: a plea for adaptation of TNM classification in upper-half esophageal carcinoma. Ann Surg 240:962–974PubMedCrossRefGoogle Scholar
  19. 19.
    Orringer MB, Marshall B, Iannettoni MD (1999) Transhiatal esophagectomy: clinical experience and refinements. Ann Surg 230:392–403PubMedCrossRefGoogle Scholar
  20. 20.
    Tachimori Y, Kato H, Watanabe H, Sasako M, Kinoshita T, Maruyama K (1996) Difference between carcinoma of the lower esophagus and the cardia. World J Surg 20:507–511PubMedCrossRefGoogle Scholar
  21. 21.
    Hoelscher AH, Bollschweiler E, Bumm R, Bartels H, Hoefler H, Siewert JR (1995) Prognostic factors of resected adenocarcinoma of the esophagus. Surgery 118:845–855CrossRefGoogle Scholar
  22. 22.
    Clark GW, Peters JH, Ireland AP, Ehsan A, Hagen JA, Kiyabu MT, Bremner CG, DeMeester TR (1994) Nodal metastasis and sites of recurrence after en bloc esophagectomy for adenocarcinoma. Ann Thorac Surg 58:646–653PubMedCrossRefGoogle Scholar
  23. 23.
    Siewert JR, Stein HJ, Feith M (2003) Surgical approach to invasive adenocarcinoma of the distal esophagus (Barrett’s cancer). World J Surg 27(9): 1058–1061PubMedCrossRefGoogle Scholar
  24. 24.
    Skinner DB, Little AG, Ferguson MK, Soriano A, Staszak VM (1986) Selection of operation for esophageal cancer based on staging. Ann Surg 204: 391–401PubMedCrossRefGoogle Scholar
  25. 25.
    Lerut T, De Leyn P, Coosemans W, Van Raemdonck D, Scheys I, LeSaffre E (1992) Surgical strategies in esophageal carcinoma with emphasis on radical lymphadenectomy. Ann Surg 216:583–590PubMedCrossRefGoogle Scholar
  26. 26.
    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 106:850–859PubMedGoogle Scholar
  27. 27.
    Junginger T, Dutkowski P (1996) Selective approach to the treatment of oesophageal cancer. Br J Surg 83:1473–1477PubMedCrossRefGoogle Scholar
  28. 28.
    Doggett RLS, Guernsey JM, Bagshaw MA (1970) Combined radiation and surgical treatment of carcinoma of the thoracic esophagus. Front Radiat Ther Oncol 5:147–154Google Scholar
  29. 29.
    Parker EF, Gregorie HB (1976) Carcinoma of the esophagus. Long-term results. JAMA 235:1018–1020PubMedCrossRefGoogle Scholar
  30. 30.
    Siewert JR, Hölscher AH (eds) Diseases of the Esophagus. Springer, Berlin Heidelberg New York TokyoGoogle Scholar
  31. 31.
    Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, Stalmeier PF, ten Kate FJ, van Dekken H, Obertop H, Tilanus HW, van Lanschot JJ (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347(21):1662–1669PubMedCrossRefGoogle Scholar
  32. 32.
    Lordick F, Stein HJ, Peschel C, Siewert JR (2004) Neoadjuvant therapy for oesophagogastric cancer. Br J Surg 91(5):540–551PubMedCrossRefGoogle Scholar
  33. 33.
    Izbicki JR, Hosch SB, Pichlmeier U, Rehders A, Busch C, Niendorf A, Passlick B, Broelsch CE, Pantel K (1997) Prognostic value of immunohistochemically identifiable tumor cells in lymph nodes of patients with completely resected esophageal cancer. New Engl J Med 337?1188–1194PubMedCrossRefGoogle Scholar
  34. 34.
    Siewert JR, Stein HJ (1998) Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg 85(11):1457–1459PubMedCrossRefGoogle Scholar
  35. 35.
    Siewert JR, Hoelscher AH, Becker K, Goessner W (1987) Kardiacarcinom: Versuch einer therapeutisch relevanten Klassifikation (Cardia cancer: attempt at a therapeutically relevant classification). Chirurg 58:25–32PubMedGoogle Scholar
  36. 36.
    Steele VE, Nettesheim P (1981) Unstable cellular differentiation in adenosquamous cell carcinoma. JNCI 67:149–154PubMedGoogle Scholar
  37. 37.
    Hsu CP, Chen CY, Hsieh YH, Hsia JY, Shai SE, Kao CH (1997) Esophageal reflux after total or proximal gastrectomy in patients with adenocarcinoma of the gastric cardia. Am J Gastroenterol 92:1347–1350PubMedGoogle Scholar
  38. 38.
    Wang LS, Chi KH, Hu MH, Fahn HJ, Huang MH (1996) Management for patients with advanced T4 epidermoid carcinoma of the esophagus. J Surg Oncol 62:22–29PubMedCrossRefGoogle Scholar
  39. 39.
    Blazeby JM, Williams MH, Brookes ST, Alderson D, Farndon JR (1995) Quality of life measurement in patients with oesophageal cancer. Gut 37:505–508PubMedCrossRefGoogle Scholar

Copyright information

© Steinkopff Verlag 2009

Authors and Affiliations

  • Wolfram T. Knoefel
    • 1
  • Ingo Alldinger
    • 1
  • Jakob R. Izbicki
    • 2
  1. 1.Department of General-, Visceral- and Pediatric SurgeryHeinrich-Heine-University of DüsseldorfDüsseldorfGermany
  2. 2.Department of General, Visceral and Thoracic SurgeryUniversity Hospital Hamburg EppendorfHamburgGermany

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