Carcinoma of the oesophagus: the time for a multidiciplinary approach?

Oesophageal cancer is one of the most lethal carcinomas, with 5-year survival rates of less than 5%. This is due to a combination of factors including late presentation, associated cardiac and respiratory disease, and the technical difficulties of resectional surgery. The outcome for patients with oesophageal cancer has changed little in recent years, perpetuating a pervading attitude of pessimism in the surgical community. The epidemiology of oesophageal cancer is changing with the increasing incidence of adenocarcinoma. Most of these tumours arise in the setting of Barrett's oesophagus and chronic gastro-oesophageal reflux disease. Survival following surgery for oesophageal cancer is determined by several independent factors, most notably the pathological stage of the disease and the patients physiological status. However, in patients with limited disease, in particular patients with less than five lymph node metastases, the extent of the nodal dissection positively impacts survival. This article reviews the changing epidemiology of oesophageal cancer, focusing on the need for early diagnosis and the selection of patients for surgery. It places emphasis on the importance of integrating surgical therapy in a multidisciplinary team approach to the management of such patients.