ReviewEvidence-Based Surgical Treatment of Esophageal Cancer: Overview of High-Quality Studies
Section snippets
Material and Methods
Systematic reviews and RCTs are considered the highest level of evidence [1, 2, 3]. For the purpose of this overview, the literature search was restricted to this highest level of evidence related to the surgical treatment of EC. Nonsurgical issues, such as (neo)-adjuvant chemo(radio)therapy, preoperative staging, and the value of a palliative resection are not addressed.
All available systematic reviews and RCTs were independently selected by two investigators (SML, BCV) by using PubMed,
Transthoracic versus transhiatal esophagectomy
Two major surgical strategies can be used to optimize outcome after esophagectomy. To improve cure, an en bloc transthoracic resection or an extended resection with two-field lymphadenectomy have been proposed. Alternatively, early postoperative morbidity and mortality may be decreased by limiting the extent of dissection using a transhiatal technique. English-language literature was systematically reviewed. With only three small RCTs (including a total of 138 patients) published at that time [7
Comment
In summary, with EC surgery there long has been a debate about the best surgical approach. Only one RCT addresses the concerns of the optimal extent of resection, in which the results suggest that fit patients are best treated by a transthoracic esophagectomy with extended en bloc (two-field) lymphadenectomy. For less fit patients or patients with junctional or cardiac tumors, transhiatal esophageal resection could suffice. Future and ongoing RCTs should establish the role of three-field
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