Review
Evidence-Based Surgical Treatment of Esophageal Cancer: Overview of High-Quality Studies

https://doi.org/10.1016/j.athoracsur.2009.09.062Get rights and content

Evidence-based medicine is the conscientious, explicit, and judicious use of best available evidence in making decisions for individual patient care. The present review gives an evidence-based review of esophageal cancer surgery. The literature search was restricted to the highest level of evidence on the surgical treatment of esophageal cancer.

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

References (54)

  • Y. Tabira et al.

    The width of a gastric tube has no impact on outcome after esophagectomy

    Am J Surg

    (2004)
  • M.A. Bhat et al.

    Use of pedicled omentum in esophagogastric anastomosis for prevention of anastomotic leak

    Ann Thorac Surg

    (2006)
  • M. Fok et al.

    Pyloroplasty versus no drainage in gastric replacement of the esophagus

    Am J Surg

    (1991)
  • D.L. Sackett et al.

    Evidence based medicine: what it is and what it isn't

    BMJ

    (1996)
  • D.L. Sackett et al.

    Evidence based medicine: what it is and what it isn't

    Clin Orthop Relat Res

    (2007)
  • D.T. Ubbink et al.

    Evidence-based surgery

    Br J Surg

    (2004)
  • J.J. van Lanschot et al.

    Hospital volume and hospital mortality for esophagectomy

    Cancer

    (2001)
  • M.W. Wouters et al.

    High-volume versus low-volume for esophageal resections for cancer: the essential role of case-mix adjustments based on clinical data

    Ann Surg Oncol

    (2008)
  • M. Goldminc et al.

    Oesophagectomy by a transhiatal approach or thoracotomy: a prospective randomized trial

    Br J Surg

    (1993)
  • C.A. Jacobi et al.

    Surgical therapy of esophageal carcinoma: the influence of surgical approach and esophageal resection on cardiopulmonary function

    Eur J Cardiothorac Surg

    (1997)
  • J.B. Hulscher et al.

    Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus

    N Engl J Med

    (2002)
  • J.M. Omloo et al.

    Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial

    Ann Surg

    (2007)
  • J.B. Hulscher et al.

    Individualised surgical treatment of patients with an adenocarcinoma of the distal oesophagus or gastro-oesophageal junction

    Dig Surg

    (2005)
  • N. Hayes et al.

    Comparison of conventional Lewis-Tanner two-stage oesophagectomy with the synchronous two-team approach

    Br J Surg

    (1995)
  • N. Hayes et al.

    Comparison of conventional Lewis-Tanner two-stage oesophagectomy with the synchronous two-team approach

    Br J Surg

    (1995)
  • E.H. Gemmill et al.

    Systematic review of minimally invasive resection for gastro-oesophageal cancer

    Br J Surg

    (2007)
  • T. Imada et al.

    Gastric emptying after gastric interposition for esophageal carcinoma: comparison between the anterior and posterior mediastinal approaches

    Hepatogastroenterology

    (1998)
  • Cited by (0)

    View full text