Treatment of Esophageal Cancer: Systematic Review on Surgical Techniques

The therapeutic management of esophageal cancer can be done through several approaches, including surgical resection, or esophagectomy, associated with lymph node dissection, as well as chemotherapy, radiation therapy or chemoradiotherapy, used alone or with surgery. The overall survival rate for this rapidly progressing cancer is low, even after treatment. In the light of an analysis produced at the request of the Comité sur l’évolution des pratiques en oncologie (CEPO), AETMIS reached the conclusion that no difference was shown between the transthoracic and transhiatal techniques in terms of postoperative mortality, regardless of histological tumour type.

En-bloc transthoracic esophagectomy improves long-term overall survival (five years) and disease-free survival when tumour resection is complete, when there is no lymph node involvement (N0) or when the number of involved lymph nodes (N1) is less than eight in patients with adenocarcinoma of the esophagus and of the gastro-esophageal junction, but increases the risk of pulmonary complications. With the transhiatal approach, the risk of recurrent laryngeal nerve lesions is high. Both surgical approaches (transthoracic and transhiatal) promote the formation of anastomotic leaks, which are more frequent when a cervical anastomosis is performed, but will have less severe consequences than thoracic or mediastinal leaks. It should be noted that because of the low incidence of esophageal cancer, the selected studies had small samples and low statistical power. Furthermore, the heterogeneity of tumour characteristics, of the case mix and of the different surgical techniques proposed does not allow for controlled studies of high methodological quality; the majority of the studies were retrospective. These studies should therefore be interpreted with caution.

This document is the second in a series of three reports on the treatment of esophageal cancer. It follows a systematic review on neoadjuvant therapy and chemoradiotherapy used alone. A third report will cover the relationship between the volume of interventions – per hospital centre and per surgeon – and the risk of short-term postoperative mortality.