Is there any role for surgery in the multidisciplinary treatment of esophageal cancer?

Due to the poor prognosis of patients after unimodal therapy like surgical resection or radiotherapy multidisciplinary treatment is regarded as standard of care in localized esophageal cancer. Within the last decade phase III trials investigating the curative potential of radiochemotherapy alone have challenged surgery to be an indispensible part of curative therapy. Nevertheless, surgical resection does play an important role in the multidisciplinary treatment. But its role is limited to subgroups of patients with a distinct clinical situation. Today it appears that particularly patients with adenocarcinomas of the lower esophagus and esophagogastric junction and those patients with squamous cell carcinomas not responding to induction chemo- or radiochemotherapy benefit from surgery. Patient selection according to their individual operative risk is most important to guide multidisciplinary therapy. Early molecular or diagnostic markers to predict response to chemo- or radiotherapy and also recurrence despite complete surgical resection are urgently needed.