Treatment of Resectable Esophageal Cancer: Indications and Long-term Results

  • Giovanni de Manzoni
  • Andrea Zanoni
  • Jacopo Weindelmayer
Part of the Updates in Surgery book series (UPDATESSURG)


The therapeutic strategy in squamous cell carcinoma of the esophagus depends on the possibility to obtain a R0 resection, which is deemed essential in the cure of this disease. An understanding of the routes of neoplastic diffusion is thus the first step in planning treatment strategy. This chapter addresses both the indications for surgical resection and the long-term results with respect to survival and patterns of recurrence.


Squamous Cell Carcinoma Esophageal Squamous Cell Carcinoma Endoscopic Resection Hepatic Arterial Infusion Chemotherapy Cervical Squamous Cell Carcinoma 
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.


  1. 1.
    Pedrazzani C, de Manzoni G, Marrelli D et al (2007) Lymph node involvement in advanced gastroesophageal junction adenocarcinoma. J Thorac Cardiovasc Surg 134:378–385PubMedCrossRefGoogle Scholar
  2. 2.
    Pennathur A, Zhang J, Chen H, Luketich JD (2010) The “best operation” for esophageal cancer? Ann Thorac Surg 89: S2163–2167CrossRefGoogle Scholar
  3. 3.
    Momma K (2010) Endoscopic diagnosis of superficial esophageal cancer. In: Society JE (ed) Endoscopic diagnosis and treatment of superficial esophageal cancer, pp 8–20Google Scholar
  4. 4.
    Stein HJ, Feith M, Bruecher BL et al (2005) Early esophageal cancer: pattern of lymphatic spread and prognostic factors for long-term survival after surgical resection. Ann Surg 242:566–573PubMedCentralPubMedGoogle Scholar
  5. 5.
    Japanese Esophageal Society (2008) Japanese Classification of Esophageal Cancer, 10th edn. Kaneara & Co, TokyoGoogle Scholar
  6. 6.
    Tachibana M, Hirahara N, Kinugasa S, Yoshimura H (2008) Clinicopathologic features of superficial esophageal cancer: results of consecutive 100 patients. Ann Surg Oncol 15:104–116PubMedCrossRefGoogle Scholar
  7. 7.
    Tachibana M, Kinugasa S, Shibakita M et al (2006) Surgical treatment of superficial esophageal cancer. Langenbecks Arch Surg 391:304–321PubMedCrossRefGoogle Scholar
  8. 8.
    Ancona E, Rampado S, Cassaro M et al (2008) Prediction of lymph node status in superficial esophageal carcinoma. Ann Surg Oncol 15:3278–3288PubMedCrossRefGoogle Scholar
  9. 9.
    Bollschweiler E, Baldus SE, Schroder et al (2006) High rate of lymph-node metastasis in submucosal esophageal squamous-cell carcinomas and adenocarcinomas. Endoscopy 38:149–156PubMedCrossRefGoogle Scholar
  10. 10.
    Mariette C, Piessen G, Triboulet JP (2007) Therapeutic strategies in oesophageal carcinoma: role of surgery and other modalities. Lancet Oncol 8:545–553PubMedCrossRefGoogle Scholar
  11. 11.
    Pasini F, de Manzoni G, Pedrazzani C et al (2005) High pathological response rate in locally advanced esophageal cancer after neoadjuvant combined modality therapy: dose finding of a weekly chemotherapy schedule with protracted venous infusion of 5-fluorouracil and dose escalation of cisplatin, docetaxel and concurrent radiotherapy. Ann Oncol 16:1133–1139PubMedCrossRefGoogle Scholar
  12. 12.
    de Manzoni G, Pedrazzani C, Pasini F et al (2007) Chemoradiotherapy followed by surgery for squamous cell carcinoma of the thoracic esophagus with clinical evidence of adjacent organ invasion. J Surg Oncol 95:261–266PubMedCrossRefGoogle Scholar
  13. 13.
    Bedenne L, Michel P, Bouche O et al (2007) Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol 25:1160–1168PubMedCrossRefGoogle Scholar
  14. 14.
    Stahl M, Stuschke M, Lehmann N et al (2005) Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol 23:2310–2317PubMedCrossRefGoogle Scholar
  15. 15.
    Gardner-Thorpe J, Hardwick RH, Dwerryhouse SJ (2007) Salvage oesophagectomy after local failure of definitive chemoradiotherapy. Br J Surg 94:1059–1066PubMedCrossRefGoogle Scholar
  16. 16.
    Tachimori Y (2009) Role of salvage esophagectomy after definitive chemoradiotherapy. Gen Thorac Cardiovasc Surg 57:71–78PubMedCrossRefGoogle Scholar
  17. 17.
    Borghesi S, Hawkins MA, Tait D (2008) Oesophagectomy after definitive chemoradiation in patients with locally advanced oesophageal cancer. Clin Oncol (R Coll Radiol) 20:221–226CrossRefGoogle Scholar
  18. 18.
    D’Journo XB, Michelet P, Dahan L et al (2008) Indications and outcome of salvage surgery for oesophageal cancer. Eur J Cardiothorac Surg 33:1117–1123PubMedCrossRefGoogle Scholar
  19. 19.
    Pinto CE, Fernandes Dde S, Sa EA, Mello EL (2009) Salvage esophagectomy after exclusive chemoradiotherapy: results at the Brazilian National Cancer Institute (INCA). Dis Esophagus 22:682–686PubMedCrossRefGoogle Scholar
  20. 20.
    Tachimori Y, Kanamori N, Uemura N et al (2009) Salvage esophagectomy after high-dose chemoradiotherapy for esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg 137:49–54PubMedCrossRefGoogle Scholar
  21. 21.
    Chen G, Wang Z, Liu XY, Liu FY (2007) Recurrence pattern of squamous cell carcinoma in the middle thoracic esophagus after modified Ivor-Lewis esophagectomy. World J Surg 31:1107–1114PubMedGoogle Scholar
  22. 22.
    Lee SJ, Lee KS, Yim YJ et al (2005) Recurrence of squamous cell carcinoma of the oesophagus after curative surgery: rates and patterns on imaging studies correlated with tumour location and pathological stage. Clin Radiol 60:547–554PubMedCrossRefGoogle Scholar
  23. 23.
    Nakagawa S, Kanda T, Kosugi S et al (2004) Recurrence pattern of squamous cell carcinoma of the thoracic esophagus after extended radical esophagectomy with three-field lymphadenectomy. J Am Coll Surg 198:205–211PubMedCrossRefGoogle Scholar
  24. 24.
    Mariette C, Piessen G, Balon JM et al (2004) Surgery alone in the curative treatment of localised oesophageal carcinoma. Eur J Surg Oncol 30:869–876PubMedCrossRefGoogle Scholar
  25. 25.
    Hsu PK, Wu YC, Chou TY et al (2010) Comparison of the 6th and 7th editions of the American Joint Committee on Cancer tumor-node-metastasis staging system in patients with resected esophageal carcinoma. Ann Thorac Surg 89:1024–1031PubMedCrossRefGoogle Scholar
  26. 26.
    Lerut T, Nafteux P, Moons J et al (2004) Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 R0 resections: impact on staging, diseasefree survival, and outcome: a plea for adaptation of TNM classification in upper-half esophageal carcinoma. Ann Surg 240:962–972PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Mariette C, Taillier G, Van Seuningen I, Triboulet JP (2004) Factors affecting postoperative course and survival after en bloc resection for esophageal carcinoma. Ann Thorac Surg 78:1177–1183PubMedCrossRefGoogle Scholar
  28. 28.
    Law S, Kwong DL, Kwok KF et al (2003) Improvement in treatment results and long-term survival of patients with esophageal cancer: impact of chemoradiation and change in treatment strategy. Ann Surg 238:339–347PubMedCentralPubMedGoogle Scholar
  29. 29.
    Thompson SK, Ruszkiewicz AR, Jamieson GG et al (2008) Improving the accuracy of TNM staging in esophageal cancer: a pathological review of resected specimens. Ann Surg Oncol 15:3447–3458PubMedCrossRefGoogle Scholar
  30. 30.
    Altorki N, Kent M, Ferrara C, Port J (2002) Three-field lymph node dissection for squamous cell and adenocarcinoma of the esophagus. Ann Surg 236:177–183PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Hyngstrom JR, Posner MC (2010) Neoadjuvant strategies for the treatment of locally advanced esophageal cancer. J Surg Oncol 101:299–304PubMedCrossRefGoogle Scholar
  32. 32.
    Lv J, Cao XF, Zhu B et al (2009) Effect of neoadjuvant chemoradiotherapy on prognosis and surgery for esophageal carcinoma. World J Gastroenterol 15:4962–4968PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Gebski V, Burmeister B, Smithers BM et al (2007) Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol 8:226–234PubMedCrossRefGoogle Scholar
  34. 34.
    Urschel JD, Vasan H (2003) A meta-analysis of randomized controlled trials that compared neoadjuvant chemoradiation and surgery to surgery alone for resectable esophageal cancer. Am J Surg 185:538–543PubMedCrossRefGoogle Scholar
  35. 35.
    Greil R, Stein HJ (2007) Is it time to consider neoadjuvant treatment as the standard of care in oesophageal cancer? Lancet Oncol 8:189–190PubMedCrossRefGoogle Scholar
  36. 36.
    Schneider BJ, Urba SG (2007) Preoperative chemoradiation for the treatment of locoregional esophageal cancer: the standard of care? Semin Radiat Oncol 17:45–52PubMedCrossRefGoogle Scholar
  37. 37.
    Leers JM, Ayazi S, Hagen JA et al (2009) Survival in lymph node negative adenocarcinoma of the esophagus after R0 resection with and without neoadjuvant therapy: evidence for downstaging of N status. J Am Coll Surg 208:553–556PubMedCrossRefGoogle Scholar
  38. 38.
    Rice TW, Blackstone EH, Adelstein DJ et al (2001) N1 esophageal carcinoma: the importance of staging and downstaging. J Thorac Cardiovasc Surg 121:454–464PubMedCrossRefGoogle Scholar
  39. 39.
    Boffa D, Detterbeck F (2009) Neoadjuvant therapy. In: Blair A., Jobe CRT, Jr, John G. Hunter (ed) Esophageal Cancer Principles and Practice. Demos Medical, New York, pp 407–422Google Scholar
  40. 40.
    Ku GY, Illson D (2009) Preoperative therapy for esophageal cancer. In: Gastroenterology Clinics of North America, vol 38._Elsevier, pp 135–152Google Scholar
  41. 41.
    Courrech Staal EF, Aleman BM, Boot H et al (2010) Systematic review of the benefits and risks of neoadjuvant chemoradiation for oesophageal cancer. Br J Surg 97:1482–1496PubMedCrossRefGoogle Scholar
  42. 42.
    de Manzoni G, Pedrazzani C, Laterza E et al (2005) Induction chemoradiotherapy for squamous cell carcinoma of the thoracic esophagus: impact of increased dosage on long-term results. Ann Thorac Surg 80:1176–1183PubMedCrossRefGoogle Scholar
  43. 43.
    Verlato G, Zanoni A, Tomezzoli A et al (2010) Response to induction therapy in oesophageal and cardia carcinoma using Mandard tumour regression grade or size of residual foci. Br J Surg 97:719–725PubMedCrossRefGoogle Scholar
  44. 44.
    Meredith KL, Weber JM, Turaga KK et al (2010) Pathologic response after neoadjuvant therapy is the major determinant of survival in patients with esophageal cancer. Ann Surg Oncol 17:1159–1167PubMedCrossRefGoogle Scholar
  45. 45.
    Meguid RA, Hooker CM, Taylor JT et al (2009) Recurrence after neoadjuvant chemoradiation and surgery for esophageal cancer: does the pattern of recurrence differ for patients with complete response and those with partial or no response? J Thorac Cardiovasc Surg 138:1309–1317PubMedCentralPubMedCrossRefGoogle Scholar
  46. 46.
    Dresner SM, Griffin SM (2000) Pattern of recurrence following radical oesophagectomy with two-field lymphadenectomy. Br J Surg 87:1426–1433PubMedCrossRefGoogle Scholar
  47. 47.
    Hsu PK, Wang BY, Huang CS et al (2011) Prognostic factors for post-recurrence survival in esophageal squamous cell carcinoma patients with recurrence after resection. J Gastrointest Surg 15:558–565PubMedCrossRefGoogle Scholar
  48. 48.
    Natsugoe S, Matsumoto M, Okumura H et al (2010) Clinical course and outcome after esophagectomy with three-field lymphadenectomy in esophageal cancer. Langenbecks Arch Surg 395:341–346PubMedCrossRefGoogle Scholar
  49. 49.
    Kang CH, Kim YT, Jeon SH et al (2007) Lymphadenectomy extent is closely related to longterm survival in esophageal cancer. Eur J Cardiothorac Surg 31:154–160PubMedCrossRefGoogle Scholar
  50. 50.
    Kunisaki C, Makino H, Takagawa R et al (2008) Surgical outcomes in esophageal cancer patients with tumor recurrence after curative esophagectomy. J Gastrointest Surg 12:802–810PubMedCrossRefGoogle Scholar
  51. 51.
    Mariette C, Balon JM, Piessen G et al (2003) Pattern of recurrence following complete resection of esophageal carcinoma and factors predictive of recurrent disease. Cancer 97:1616–1623PubMedCrossRefGoogle Scholar
  52. 52.
    Smit JK, Pultrum BB, van Dullemen HM et al (2010) Prognostic factors and patterns of recurrence in esophageal cancer assert arguments for extended two-field transthoracic esophagectomy. Am J Surg 200:446–453PubMedCrossRefGoogle Scholar
  53. 53.
    Tachibana M, Kinugasa S, Yoshimura H et al (2005) Clinical outcomes of extended esophagectomy with three-field lymph node dissection for esophageal squamous cell carcinoma. Am J Surg 189:98–109PubMedCrossRefGoogle Scholar
  54. 54.
    Shim YM, Kim HK, Kim K (2010) Comparison of survival and recurrence pattern between two-field and three-field lymph node dissections for upper thoracic esophageal squamous cell carcinoma. J Thorac Oncol 5:707–712PubMedCrossRefGoogle Scholar
  55. 55.
    Rohatgi PR, Swisher SG, Correa AM et al (2005) Failure patterns correlate with the proportion of residual carcinoma after preoperative chemoradiotherapy for carcinoma of the esophagus. Cancer 104:1349–1355PubMedCrossRefGoogle Scholar
  56. 56.
    Vallbohmer D, Holscher AH, DeMeester S et al (2010) A multicenter study of survival after neoadjuvant radiotherapy/chemotherapy and esophagectomy for ypT0N0M0R0 esophageal cancer. Ann Surg 252:744–749PubMedCrossRefGoogle Scholar
  57. 57.
    Schipper PH, Cassivi SD, Deschamps C et al (2005) Locally recurrent esophageal carcinoma: when is re-resection indicated? Ann Thorac Surg 80:1001–1005PubMedCrossRefGoogle Scholar
  58. 58.
    Nakamura T, Ota M, Narumiya K et al (2008) Multimodal treatment for lymph node recurrence of esophageal carcinoma after curative resection. Ann Surg Oncol 15:2451–2457PubMedCrossRefGoogle Scholar
  59. 59.
    Kato H, Miyazaki T, Nakajima M et al (2003) Prediction of hematogenous recurrence in patients with esophageal carcinoma. Jpn J Thorac Cardiovasc Surg 51:599–608PubMedCrossRefGoogle Scholar
  60. 60.
    Pawlik TM, Gleisner AL, Bauer TW et al (2007) Liver-directed surgery for metastatic squamous cell carcinoma to the liver: results of a multi-center analysis. Ann Surg Oncol 14: 2807–2816PubMedCrossRefGoogle Scholar
  61. 61.
    Nakajima Y, Nagai K, Kawano T et al (2001) Therapeutic strategy for postoperative liver metastasis from esophageal squamous cell carcinoma; clinical efficacy of and problem with hepatic arterial infusion chemotherapy. Hepatogastroenterology 48:1652–1655PubMedGoogle Scholar
  62. 62.
    Shiono S, Kawamura M, Sato T (2008) Disease-free interval length correlates to prognosis of patients who underwent metastasectomy for esophageal lung metastases. J Thorac Oncol 3:1046–1049PubMedCrossRefGoogle Scholar
  63. 63.
    Ichikawa H, Kosugi S, Nakagawa S et al (2011) Operative treatment for metachronous pulmonary metastasis from esophageal carcinoma. Surgery 149:164–170PubMedCrossRefGoogle Scholar
  64. 64.
    Chen F, Sato K, Sakai H (2008) Pulmonary resection for metastasis from esophageal carcinoma. Interact Cardiovasc Thorac Surg 7:809–812PubMedCrossRefGoogle Scholar
  65. 65.
    Weinberg JS, Suki D, Hanbali F et al (2003) Metastasis of esophageal carcinoma to the brain. Cancer 98:1925–1933PubMedCrossRefGoogle Scholar
  66. 66.
    Rice TW, Khuntia D, Rybicki LA et al (2006) Brain metastases from esophageal cancer: a phenomenon of adjuvant therapy? Ann Thorac Surg 6:2042–2049CrossRefGoogle Scholar
  67. 67.
    Yoshida S (2007) Brain metastasis in patients with esophageal carcinoma. Surg Neurol 67:288–290PubMedCrossRefGoogle Scholar
  68. 68.
    Ogawa K, Toita T, Sueyama H et al (2002) Brain metastases from esophageal carcinoma: natural history, prognostic factors, and outcome. Cancer 94:759–764PubMedCrossRefGoogle Scholar
  69. 69.
    Kosuga T, Shiozaki A, Fujiwara H et al (2011) Treatment outcome and prognosis of patients with lymph node recurrence of thoracic esophageal squamous cell carcinoma after curative resection. World J Surg 35:798–804PubMedCrossRefGoogle Scholar
  70. 70.
    Kato H, Tachimori Y, Watanabe H et al (1998) Anastomotic recurrence of oesophageal squamous cell carcinoma after transthoracic oesophagectomy. Eur J Surg 164:759–764PubMedCrossRefGoogle Scholar
  71. 71.
    Shimada H, Kitabayashi H, Nabeya Y et al (2003) Treatment response and prognosis of patients after recurrence of esophageal cancer. Surgery 133:24–31PubMedCrossRefGoogle Scholar
  72. 72.
    Kaisaki S, Kitayama J, Ishigami H, Nagawa H (2007) Solitary nodal recurrence in the dorsal area of the thoracic aorta after a curative resection of esophageal cancer: report of two cases. Surg Today 37:243–247PubMedCrossRefGoogle Scholar
  73. 73.
    Yano M, Takachi K, Doki Y et al (2006) Prognosis of patients who develop cervical lymph node recurrence following curative resection for thoracic esophageal cancer. Dis Esophagus 19:73–77PubMedCrossRefGoogle Scholar
  74. 74.
    Motoyama S, Kitamura M, Saito R et al (2006) Outcome and treatment strategy for mid-and lower-thoracic esophageal cancer recurring locally in the lymph nodes of the neck. World J Surg 30:191–198PubMedCrossRefGoogle Scholar
  75. 75.
    Komatsu S, Shioaki Y, Ichikawa D et al (2005) Survival and clinical evaluation of salvage operation for cervical lymph node recurrence in esophageal cancer. Hepatogastroenterology 52:796–799PubMedGoogle Scholar
  76. 76.
    Sato Y, Motoyama S, Maruyama K et al (2005) A second malignancy is the major cause of death among thoracic squamous cell esophageal cancer patients negative for lymph node involvement. J Am Coll Surg 201:188–193PubMedCrossRefGoogle Scholar
  77. 77.
    Sugiura T, Kato H, Tachimori Y et al (2002) Second primary carcinoma in the gastric tube constructed as an esophageal substitute after esophagectomy. J Am Coll Surg 194:578–583PubMedCrossRefGoogle Scholar
  78. 78.
    Bamba T, Kosugi S, Takeuchi M et al (2010) Surveillance and treatment for second primary cancer in the gastric tube after radical esophagectomy. Surg Endosc 24:1310–1317PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • Giovanni de Manzoni
    • 1
  • Andrea Zanoni
  • Jacopo Weindelmayer
  1. 1.Dept. of Surgery, Upper G.I. Surgery DivisionUniversity of VeronaVeronaItaly

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