Esophageal cancer remains a deadly disease with increasing incidence and little hope for a long-term cure, since most of cases are discovered and diagnosed too late in their course. The goal of therapy in these patients is adequate swallowing and hopefully long-term palliation, which is still best accomplished by surgery, but is operator and operation dependent.

At present there is no proven benefit for survival demonstrated from most randomized trials using perioperative chemoradiation therapy, and in fact there may be some detriment with increased morbidity and mortality especially in older patients. Before recommending chemoradiation as a standard of care for these patients, prospective randomized controlled studies must be undertaken in a well-designed manner to prevent bias clouding the results in this group of patients.

Currently, published reports demonstrate the best palliation is achieved with surgery, yet lacking a significant survival advantage over chemoradiation. Recent reports seem to demonstrate that the best palliation is achieved with a transhiatal esophagectomy.  These reports also show that patients can expect a 6-7 day hospital stay with no ICU admission, no ventilator support postoperatively in over 95% of patients, and discharge from the hospital on a regular diet, without the need for supplemental tube feeding in over 97% of the cases included in our analysis.

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