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Review

Surgical Therapy of Esophageal Adenocarcinoma—Current Standards and Future Perspectives

by
Wolfgang Schröder
1,*,
Suzanne S. Gisbertz
2,
Daan M. Voeten
2,
Christian A. Gutschow
3,
Hans F. Fuchs
1 and
Mark I. van Berge Henegouwen
2
1
Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
2
Cancer Center Amsterdam, Department of Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
3
Department of General and Transplantation Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
*
Author to whom correspondence should be addressed.
Cancers 2021, 13(22), 5834; https://doi.org/10.3390/cancers13225834
Submission received: 2 October 2021 / Revised: 15 November 2021 / Accepted: 18 November 2021 / Published: 21 November 2021
(This article belongs to the Special Issue Current and Future Treatment Strategies for Esophageal Adenocarcinoma)

Simple Summary

Subtotal resection of the esophagus with resection of local lymph nodes is the oncological procedure of choice for advanced esophageal cancer. Reconstruction of the intestinal tract is predominantly performed with a gastric tube. Even in specialized centers, this surgical procedure is associated with a high complication but low mortality rate. Therefore, clinical research aims to develop peri- and intra-operative strategies to improve the patient related outcome.

Abstract

Transthoracic esophagectomy is currently the predominant curative treatment option for resectable esophageal adenocarcinoma. The majority of carcinomas present as locally advanced tumors requiring multimodal strategies with either neoadjuvant chemoradiotherapy or perioperative chemotherapy alone. Minimally invasive, including robotic, techniques are increasingly applied with a broad spectrum of technical variations existing for the oncological resection as well as gastric reconstruction. At the present, intrathoracic esophagogastrostomy is the preferred technique of reconstruction (Ivor Lewis esophagectomy). With standardized surgical procedures, a complete resection of the primary tumor can be achieved in almost 95% of patients. Even in expert centers, postoperative morbidity remains high, with an overall complication rate of 50–60%, whereas 30- and 90-day mortality are reported to be <2% and <6%, respectively. Due to the complexity of transthoracic esophagetomy and its associated morbidity, esophageal surgery is recommended to be performed in specialized centers with an appropriate caseload yet to be defined. In order to reduce postoperative morbidity, the selection of patients, preoperative rehabilitation and postoperative fast-track concepts are feasible strategies of perioperative management. Future directives aim to further centralize esophageal services, to individualize surgical treatment for high-risk patients and to implement intraoperative imaging modalities modifying the oncological extent of resection and facilitating surgical reconstruction.
Keywords: esophageal adenocarcinoma; transthoracic esophagectomy; minimally invasive (robotic) techniques: perioperative management; patient selection; surgical outcome esophageal adenocarcinoma; transthoracic esophagectomy; minimally invasive (robotic) techniques: perioperative management; patient selection; surgical outcome

Share and Cite

MDPI and ACS Style

Schröder, W.; Gisbertz, S.S.; Voeten, D.M.; Gutschow, C.A.; Fuchs, H.F.; van Berge Henegouwen, M.I. Surgical Therapy of Esophageal Adenocarcinoma—Current Standards and Future Perspectives. Cancers 2021, 13, 5834. https://doi.org/10.3390/cancers13225834

AMA Style

Schröder W, Gisbertz SS, Voeten DM, Gutschow CA, Fuchs HF, van Berge Henegouwen MI. Surgical Therapy of Esophageal Adenocarcinoma—Current Standards and Future Perspectives. Cancers. 2021; 13(22):5834. https://doi.org/10.3390/cancers13225834

Chicago/Turabian Style

Schröder, Wolfgang, Suzanne S. Gisbertz, Daan M. Voeten, Christian A. Gutschow, Hans F. Fuchs, and Mark I. van Berge Henegouwen. 2021. "Surgical Therapy of Esophageal Adenocarcinoma—Current Standards and Future Perspectives" Cancers 13, no. 22: 5834. https://doi.org/10.3390/cancers13225834

APA Style

Schröder, W., Gisbertz, S. S., Voeten, D. M., Gutschow, C. A., Fuchs, H. F., & van Berge Henegouwen, M. I. (2021). Surgical Therapy of Esophageal Adenocarcinoma—Current Standards and Future Perspectives. Cancers, 13(22), 5834. https://doi.org/10.3390/cancers13225834

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