B21, 22. Squamocellular carcinoma and adenocarcinoma of the oesophagus and their surgical management

Page created on September 14, 2021. Last updated on April 10, 2022 at 12:03


For introduction, epidemiology, and etiology, see the corresponding pathology 2 topic. For clinical features, diagnosis and evaluation, and medical treatment, see the corresponding internal medicine topic.


Proper evaluation and staging are essential to determine the resectability of the disease. Only around 1/3 of patients are operated on.

In the rare case where very early cancers are discovered, we may use minimally invasive methods like endoscopic resection or laser ablation.

Most patients present in a stage where radical surgery is required for cure. However, oesophageal resection is a large and complicated procedure, and patients often develop post-operative complications like nutritional problems, stenosis in the anastomosis, and slow passage of foodstuffs.

After surgical resection of the oesophagus, either total or partial, the resected part of the oesophagus should be substituted with stomach (first choice) or colon. Because of the localisation of the oesophagus, oesophageal surgery may involve the neck, thorax, and/or the abdomen, making for a large and complicated surgery.

Surgery may be performed open, laparoscopically, or in combination.

Locally advanced oesophageal cancer is treated with neoadjuvant chemoradiation, followed by surgery if the tumour is considered resectable on restaging.

Palliative therapy is often employed for stage IV disease. The placement of stents is the major palliative option for oesophageal cancer.

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