Long-term survival of surgical treatment of esophageal squamous cell carcinoma in Europe: the story of current practice in multimodal treatment

Squamous cell carcinoma is still the most common histological subtype of esophageal carcinoma in Europe, although its incidence is decreasing, while incidence of adenocarcinoma is rapidly increasing, especially in Western and Northern countries. Curative treatment is still surgery based, but unlike in most Asian countries, most patients receive multimodal treatment. Based on recent randomized trials, European guidelines mention neoadjuvant chemoradiation therapy followed by surgery or definitive chemoradiation followed by salvage resection when needed as treatment options in locally advanced esophageal squamous cell carcinoma patients. The trend towards more definitive chemoradiation can be explained by the possibility to have an organ-sparing treatment on one hand, but on the other hand also by the fact that most European esophageal surgeons are visceral surgeons who are less familiar with lymph node dissections in the upper mediastinum and neck. Nevertheless, surgical treatment with adequate lymph node dissection as part of a multimodal treatment still offers the best chances on long term survival with 5-year survival rates of up to more than 40 percent.