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

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.