Thirty years ago, esophageal cancer was a terrible disease, and many surgeons were discouraged by the miserable outcome. The first goal of specialists in the treatment of esophageal cancer was the achievement of safe surgery which would decrease the postoperative complications of anastomotic leakage and pulmonary problems. Anastomotic leakage could be decreased clearly by several percentage points by using the whole stomach as an esophageal substitute. Pulmonary complications were also decreased by using a new instrument for pericutaneous intubation of the trachea. We have emphasized that excess surgical stress or postoperative complications could contribute to the enhancement of tumor metastasis and to a poor prognosis, both of which have been proven experimentally and clinically. We proposed that this phenomenon be termed“surgical oncotaxis”. We have reported that regulation of cytokine storms with radical scavengers or corticosteroids could control this surgical oncotaxis. After success in safe surgery for esophageal cancer, improvement of survival was attempted with an extended radical lymphadenectomy or by adjuvant chemo-radiotherapies combined with an operation. The extended radical lymphadenectomy did not contribute to improvement of survival in spite of intensive effort and a change was made to a concentrated lymphadenectomy based on a technique using sentinel navigation or biomarkers. Various adjuvant therapies have been also developed, and the survival has gradually improved. These days, chemo-radiotherapy with new drugs is expected to improve survival dramatically. Furthermore, chemo-sensitivity tests with new techniques will play an important role. Recently, biological approaches have developed and came into use clinically. Our dream is to realize individualization of therapy and improvement of the outcome. This is being realized step by step.
In this paper, our history of the improvement of the outcome for esophageal cancer patients and prospects for the future was discussed.
- 平井 敏弘，他