Early esophageal and gastric cancers : surgery in the era of minimally invasive treatment

Surgery represents today the standard treatment of oesophageal and gastric cancer. Associated morbidity remain however signifi- cant in term of incisional access and functional sequels after organ resection and extended lymphadenectomy. Retrospective reviews of surgical series have defined indications for which more conser- vative treatment appears to provide similar survival without the need for lymph node resection. Endoscopic resection is now accepted for the treatment of well-differentiated tumors restricted to the mucosa. The expansion of this technique to deeper lesions or to lesions developed on a background of metaplasia is associated with an increased morbidity and significant risk of recurrence as well as a lifelong, close endoscopic surveillance. The role of surgery as primary treatment or rescue therapy to extend the resection will rely on an accurate preoperative and pathological staging of the lesion. Laparoscopy can play a central role in the management of early oesophageal and gastric cancer as it can permit from localized to extensive resection associated to lymph node dissection with the advantage of minimal invasive surgery. Its association to function-preserving operations awaits the demonstrated efficacy of targeted lymph node dissection. Those new techniques should be restricted to centres with extensive expertise and need to be validated in long-term controlled studies. (Acta gastroenterol. belg., 2006, 69, 312-316).