Journal of Surgery (ISSN: 2575-9760)

Article / review article

"Esophageal Cancer: Current and Evolving Treatment Landscape"

Nicole B. Balmaceda1, Joaquina C. Baranda2, Peter DiPasco3, Weijing Sun2, John Ashcraft3, Joseph Valentino3 and Mazin Al-Kasspooles3

1 University of Kansas School of Medicine, University of Kansas, Kansas, USA

2 Department of Hematology and Medical Oncology, University of Kansas Cancer Center, Westwood, USA

3 Department of Surgery, University of Kansas, Kansas, USA

*Corresponding author: Nicole B. Balmaceda, University of Kansas School of Medicine, University of Kansas

3901 Rainbow Blvd, Kansas City, Kansas 66160, USA. Email: nbalmaceda2@kumc.edu

Received Date: 04 May, 2019; Accepted Date: 17 May, 2019; Published Date: 22 May, 2019

Abstract

With advances in state-of-the-art technology, trendy diagnostic and prognostic molecular markers, and cutting-edge surgical techniques, the overall survival for patients with many types of cancers has improved. However, there is a disconnect between esophageal cancer and the acceleration in cancer care seen in other malignancies. Based on data reported by Surveillance, Epidemiology, and End Results Program (SEER), the 5-year survival rate for patients with esophageal cancer is only 19.9% [1]. Poor prognosis is likely due to an overwhelming number of patients with advanced disease during the time of diagnosis, and is also reflective of the unsatisfactory outcomes from current treatments.

In this article, we will review the epidemiology and the recently revised staging of esophageal and esophagogastric junction cancers. We will discuss the current roles of endoscopic resection, surgery, radiation therapy, and systemic therapy used individually, or as components of multimodality treatment. We will describe the changes in treatment landscape with targeted therapy and immunotherapy. The focus of clinical investigations continues to shift from the traditional empiric chemotherapy to more individualized treatments based on molecular oncology and use of immunotherapy. Further identification of prognostic values may help clarify the optimal approach to treatment and management for patients with esophageal cancer, and hopefully improve survival.


Transhiatal

Upper midline laparotomy and left neck incisions allow dissection of the middle and distal thirds of the esophagus. Thoracic esophagus is mobilized and blunt dissection through the diaphragmatic hiatus is performed. A gastric tube is created, and anastomosis is made with cervical esophagus. Some studies have shown that transhiatal esophagectomy is associated with a lower 30-day morbidity and mortality compared to the transthoracic approach; however, some studies report better oncologic outcomes with en bloc transthoracic esophagectomy [20-23].

Ivor-Lewis Transthoracic

This technique involves right thoracotomy and abdominal laparotomy. Esophagus is divided at or above the level of the azygous vein. Gastric tube, like the one employed in transhiatal esophagectomy, is created and anastomosed at this location.

Tri-incisional (McKeown)

Three incisions are made, combining thoracotomy, laparotomy, and neck incision. Thoracotomy allows en bloc resection including esophagus and mediastinal and upper abdominal lymph nodes. Laparotomy is utilized for abdominal exploration and stomach mobilization for gastric conduit. Lastly, neck incision allows exposure to create an esophagogastric anastomosis.

Minimally invasive

A minimally invasive technique, as compared to the aforementioned open esophagectomy approaches, provides smaller incisions, less blood loss, decreased postoperative pain, faster return to bowel function, decreased ICU and hospital stay, and improved cosmetic appearance compared to the conventional open procedures [24]. With this technique, surgeons are able to perform with or without thoracoscopic dissection of intrathoracic esophagus.

Table 1: Esophagectomy Techniques.

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Citation: Balmaceda NB, Baranda JC, DiPasco P, Sun W, John Ashcraft J, et al. (2019) Esophageal Cancer: Current and Evolving Treatment Landscape. J Surg 12: 1220. DOI: 10.29011/2575-9760.001220

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