Individualized and minimally invasive surgical treatment for esophageal cancer.

Intralumenal endoscopic treatment is an optimal and minimally invasive treatment for superficial esophageal cancer without risk of regional lymph node metastasis. Definitive chemoradiation therapy for potentially resectable esophageal cancer is another hot topic. A randomized control trial (RCT) with definitive chemoradiation and curative esophagectomy for cT1bN0 thoracic esophageal cancer is now ongoing as a study by the Japan Clinical Oncology Group. We must await the final results of this RCT to optimize an initial treatment for cT1bN0 thoracic esophageal cancer. Radical esophagectomy with extensive lymph node dissection is a basic requirement of curative surgical treatment for esophageal cancer with a potential risk of lymph node metastasis. This procedure is one of the most invasive surgeries in the field of management of gastrointestinal malignancies. Since the mid-1980s, radical esophagectomy with 3-field lymphadenectomy has been established and intensively performed in leading institutes in Japan. Although relatively acceptable long-term outcomes have been reported, substantial evidence of survival benefit is not proved by randomized controlled t r ials. In most Western countries, surgical resection is generally considered to be a part of multimodal approaches for esophageal cancer because of limited local control and high morbidity. Even in Japan, the mortality rate after esophageal surgery is reported in a nationwide survey to reach 3%–4%. On the other hand, the number of poor-risk patients with comorbidity is increasing. To reduce mortality and morbidity rates after radical esophagectomy, the establishment of minimally invasive and individualized surgical approaches is required. In this article, I would like to focus on the surgical approaches to relatively early stage esophageal cancer without indication of endoscopic treatment.