Esophageal Cancer; Preoperative management and postoperative outcome

Esophageal cancer is a highly aggressive disease with a rising incidence, especially in the Western World. Almost half of the patients who present with esophageal cancer are beyond curative therapy, and for patients with potentially curable disease, 5-year survival rates rarely exceed 30%. Although surgical resection is the most important part of the treatment, evidence in favor of neoadjuvant treatment (i.e. chemo(radio)therapy prior to surgery) is accumulating. These multimodality treatment regimens can induce shrinkage of the tumor and thereby facilitate a microscopically radical resection, which is an important prognostic factor for survival. However, this potential benefit should outweigh the toxicity that neoadjuvant treatment adds to the already high morbidity and mortality that are associated with the curative resection of esophageal cancer.
This thesis consists of two parts. In part one: “Preoperative analysis and treatment” the benefits of neoadjuvant chemoradiotherapy (nCRT) are described and the impact of several (pre-)clinical delays in the treatment are evaluated. Part two: “Postoperative outcome and prognostication” focusses on (disease-free) survival and prognostication after potentially curative treatment.