How Multimodal Treatment Improves Surgery for Oesophageal Cancer

Abstract

Elroy Patrick Weledji*

Background: Oesophageal cancer is one of the most challenging pathological conditions confronting the surgeon. The best practice is for the treatment of oesophageal cancer to be arranged and planned by a multidisciplinary team. The decision would be made for either surgery with or without neo-adjuvant chemo/chemoradiotherapy, chemoradiotherapy alone if not fit for or refused surgery although adenocarcinoma is resistant to radiotherapy and palliative procedures in metastatic or advanced disease. The surgical decisions are taken based upon predicted prognosis and effect of intervention upon quality of life. Various combined modality approaches have been attempted to improve outcome. The article reviewed how multimodal treatment may improve the outcome of surgery for oesophageal cancer.

Summary: Treatment of oesophageal cancer by surgery is for loco-regional control, but cure entails in addition neo-adjuvant or adjuvant chemo/chemoradiotherapy for the putative micrometastases. Cure by surgery as a definitive treatment modality is possible for early cancers. Multimodal treatment improves the outcome of surgery for oesophageal cancer. The reasons for poor survival are the late presentation of symptoms, the longitudinal submucosa lymphatic spread accounting for a high rate of resection margin positivity, and the often elderly cohort with multiple co-morbidities.