J.Jpn. Surg. Soc.. 109(6): 333-337, 2008

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Feature topic

THERAPEUTIC STRATEGIES FOR ADVANCED RESPECTABLE ESOPHAGEAL CANCER

There are obvious differences in the clinical characteristics of patients with advanced respectable esophageal cancer between Japan and Western countries. In Japan, more than 90% of patients with esophageal cancer are histologically diagnosed with squamous cell carcinoma. On the other hand, the incidence of esophageal adenocarcinoma is rapidly increasing in the West. As a standard surgical approach, relatively invasive transthoracic extended esophagectomy has been established in Japan since the 1980s and has contributed to improved long-term survival of patients with squamous cell carcinoma. The current standard care for resectable stage II/III esophageal squamous cell carcinoma is neoadjuvant chemotherapy with 5-fluorouracil/cisplatin and radical esophagectomy based on the results of Japan Clinical Oncology Group trial 9907. In the West, relatively less invasive transhiatal esophagectomy with limited lymph node dissection has played a role in the multidisciplinary treatment of esophageal adenocarcinoma. Recently, a multimodal approach to esophageal cancer treatment including definitive chemoradiotherapy has been a focus of attention in both Japan and the West. For the further improvement of long-term survival of patients with esophageal cancer, the optimization of multimodal treatments and establishment of a global standard are essential.

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