| Abstract: |
Surgery for locally advanced esophageal cancer in the current era implies surgery after pre-operative chemoradiation. There have been many concerns regarding esophagectomy following neo-adjuvant chemo-radiotherapy, including the perceived added risks from preoperative therapy. Many of these concerns have been allayed following the publication of the CROSS trial, where no added complications were noted. It should be noted, however, that this trial did not resolve the questions of the added risks in the elderly and in patients with neck anastomoses following chemoradiation, nor did it clarify whether there are added risks in patients who receive definitive chemoradiation and then undergo a salvage esophagectomy. There are also technical considerations specific to esophagectomy after chemoradiation. These include the extent of the lymphadenectomy and the importance of margins. The goals of the operation should be to resect all sites of disease, including those which were present prior to the initiation of chemoradiation but which were "down-staged" due to treatment effect. © 2001, 2006, 2015 by John Wiley & Sons, Ltd. All rights reserved. |
