Surgical Treatment of Esophageal Cancer

Background: Esophageal cancer was the seventh most common cancer worldwide in 2020 and the sixth leading cause of cancer-related deaths (544,000 deaths annually), accounting for one-eighteenth of all cancer-related deaths. In Korea, esophageal cancer accounted for 1.0% of all cancer cases, with 2,483 cases diagnosed in 2017, making it the fifteenth most common cancer and the eleventh most common cause of cancer-related deaths. Current Concepts: Esophageal squamous cell cancer (ESCC) is the most prevalent pathology (91.2%) in Korea, typically affecting the upper and middle esophagus. The common causes of ESCC are smoking, drinking, and hot beverages. ESCC lesions confined to the mucosa, such as cTis and cT1a, can be treated with endoscopic resection, but lesions invading the submucosa require esophagectomy. Patients with locally advanced ESCC with lymph node metastasis require neoadjuvant therapy followed by esophagectomy and reconstruction. Esophagectomy is associated with mortality and morbidity rates of 3% and 50%, respectively. Discussion and Conclusion: ESCC is associated with a poorer prognosis compared to those associated with other cancers, and the high mortality and morbidity rates associated with esophagectomy often lead to hesitation toward aggressive treatments. However, recent advances in chemotherapy, radiation therapy, and surgery can offer hope for a cure. Minimally invasive esophagectomy may reduce the rate of fatal complications. The shift from traditional platinum-based chemotherapy to immune checkpoint inhibitors also suggests promise for the treatment outcomes of ESCC.