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In this review we discuss the different strategies to improve surgical outcomes after potentially curative resection for oesophageal adenocarcinoma. For tumours of the distal oesophagus, there is a 17% survival benefit after transthoracic resection with two-field lymph node dissection when compared with transhiatal resection. This survival benefit is absent for tumours of the gastro-oesophageal junction or gastric cardia. These patients should, in the absence of tumour-positive lymph nodes at or proximal to the carina, undergo a transhiatal resection to minimise peri-operative complications. New developments include endoscopic resection or minimally invasive oesophagectomy, but these therapies should still be considered experimental.

Individualised Surgical Treatment of Patients with an Adenocarcinoma of the Distal Oesophagus or Gastro-Oesophageal Junction