An update on developments in curative treatment for locally advanced esophageal cancer: a narrative review

B. Feike Kingma; Cezanne D. Kooij; Jelle P. Ruurda; Richard van Hillegersberg

doi:10.21037/aoe-25-3

An update on developments in curative treatment for locally advanced esophageal cancer: a narrative review

B. Feike Kingma^*
, Cezanne D. Kooij
, Jelle P. Ruurda
, Richard van Hillegersberg

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

16 Downloads (Pure)

Abstract

Background and Objective: Esophageal cancer remains associated with relatively poor outcomes, indicated by 5-year survival rates of merely 40–50% even with optimal multimodal treatment in case of resectable disease. However, in recent years, important developments have been made regarding key aspects of treatment that include the application of neoadjuvant or perioperative chemo(radio)therapy, an adequate esophagectomy procedure, and a multidisciplinary approach to perioperative care. This narrative review provides an update of literature on these aspects of curative treatment for locally advanced esophageal cancer. Methods: This narrative review included studies by means of searches on PubMed/Embase and Scopus until April 27^th, 2025. Key Content and Findings: Evidence is increasing for perioperative FLOT for adenocarcinomas as an alternative, to neoadjuvant chemoradiotherapy, based on the randomized controlled FLOT-4 and ESOPEC trials. For squamous cell carcinoma, the recent NExT trial demonstrated that triplet neoadjuvant chemotherapy achieves the highest overall survival rate at the cost of an increased incidence of febrile neutropenia, as compared to neoadjuvant doublet chemotherapy or neoadjuvant chemoradiotherapy. While still in its global implementation phase, robot-assisted minimally invasive esophagectomy has satisfying outcomes and seems to improve lymph node yield when compared to conventional minimally invasive esophagectomy. Enhanced recovery after surgery (ERAS) protocols can effectively accelerate recovery and reduce length of hospital stay, although literature is not consistent regarding the hypothesized benefits of ERAS parts such as prehabilitation. Conclusions: Recent advancements in multimodality treatment, surgical techniques, and multidisciplinary have positively impacted outcomes for esophageal cancer patients. Future studies are warranted to investigate how survival can be further improved.

Original language	English
Article number	11
Journal	Annals of Esophagus
Volume	8
DOIs	https://doi.org/10.21037/aoe-25-3
Publication status	Published - 30 Jun 2025

Keywords

esophageal cancer
esophagectomy
robot assisted minimally invasive esophagectomy (RAMIE)
Robotic surgery

Access to Document

10.21037/aoe-25-3Licence: CC BY-NC-ND

An update on developments in curative treatment for locally advanced esophageal cancer: a narrative reviewFinal published version, 163 KBLicence: CC BY-NC-ND

Cite this

@article{8e27177bcdc842a68ed1a71288428ff1,

title = "An update on developments in curative treatment for locally advanced esophageal cancer: a narrative review",

abstract = "Background and Objective: Esophageal cancer remains associated with relatively poor outcomes, indicated by 5-year survival rates of merely 40–50\% even with optimal multimodal treatment in case of resectable disease. However, in recent years, important developments have been made regarding key aspects of treatment that include the application of neoadjuvant or perioperative chemo(radio)therapy, an adequate esophagectomy procedure, and a multidisciplinary approach to perioperative care. This narrative review provides an update of literature on these aspects of curative treatment for locally advanced esophageal cancer. Methods: This narrative review included studies by means of searches on PubMed/Embase and Scopus until April 27th, 2025. Key Content and Findings: Evidence is increasing for perioperative FLOT for adenocarcinomas as an alternative, to neoadjuvant chemoradiotherapy, based on the randomized controlled FLOT-4 and ESOPEC trials. For squamous cell carcinoma, the recent NExT trial demonstrated that triplet neoadjuvant chemotherapy achieves the highest overall survival rate at the cost of an increased incidence of febrile neutropenia, as compared to neoadjuvant doublet chemotherapy or neoadjuvant chemoradiotherapy. While still in its global implementation phase, robot-assisted minimally invasive esophagectomy has satisfying outcomes and seems to improve lymph node yield when compared to conventional minimally invasive esophagectomy. Enhanced recovery after surgery (ERAS) protocols can effectively accelerate recovery and reduce length of hospital stay, although literature is not consistent regarding the hypothesized benefits of ERAS parts such as prehabilitation. Conclusions: Recent advancements in multimodality treatment, surgical techniques, and multidisciplinary have positively impacted outcomes for esophageal cancer patients. Future studies are warranted to investigate how survival can be further improved.",

keywords = "esophageal cancer, esophagectomy, robot assisted minimally invasive esophagectomy (RAMIE), Robotic surgery",

author = "Kingma, \{B. Feike\} and Kooij, \{Cezanne D.\} and Ruurda, \{Jelle P.\} and \{van Hillegersberg\}, Richard",

note = "Publisher Copyright: {\textcopyright} AME Publishing Company.",

year = "2025",

month = jun,

day = "30",

doi = "10.21037/aoe-25-3",

language = "English",

volume = "8",

journal = "Annals of Esophagus",

publisher = "AME Publishing Company",

}

TY - JOUR

T1 - An update on developments in curative treatment for locally advanced esophageal cancer

T2 - a narrative review

AU - Kingma, B. Feike

AU - Kooij, Cezanne D.

AU - Ruurda, Jelle P.

AU - van Hillegersberg, Richard

N1 - Publisher Copyright: © AME Publishing Company.

PY - 2025/6/30

Y1 - 2025/6/30

N2 - Background and Objective: Esophageal cancer remains associated with relatively poor outcomes, indicated by 5-year survival rates of merely 40–50% even with optimal multimodal treatment in case of resectable disease. However, in recent years, important developments have been made regarding key aspects of treatment that include the application of neoadjuvant or perioperative chemo(radio)therapy, an adequate esophagectomy procedure, and a multidisciplinary approach to perioperative care. This narrative review provides an update of literature on these aspects of curative treatment for locally advanced esophageal cancer. Methods: This narrative review included studies by means of searches on PubMed/Embase and Scopus until April 27th, 2025. Key Content and Findings: Evidence is increasing for perioperative FLOT for adenocarcinomas as an alternative, to neoadjuvant chemoradiotherapy, based on the randomized controlled FLOT-4 and ESOPEC trials. For squamous cell carcinoma, the recent NExT trial demonstrated that triplet neoadjuvant chemotherapy achieves the highest overall survival rate at the cost of an increased incidence of febrile neutropenia, as compared to neoadjuvant doublet chemotherapy or neoadjuvant chemoradiotherapy. While still in its global implementation phase, robot-assisted minimally invasive esophagectomy has satisfying outcomes and seems to improve lymph node yield when compared to conventional minimally invasive esophagectomy. Enhanced recovery after surgery (ERAS) protocols can effectively accelerate recovery and reduce length of hospital stay, although literature is not consistent regarding the hypothesized benefits of ERAS parts such as prehabilitation. Conclusions: Recent advancements in multimodality treatment, surgical techniques, and multidisciplinary have positively impacted outcomes for esophageal cancer patients. Future studies are warranted to investigate how survival can be further improved.

AB - Background and Objective: Esophageal cancer remains associated with relatively poor outcomes, indicated by 5-year survival rates of merely 40–50% even with optimal multimodal treatment in case of resectable disease. However, in recent years, important developments have been made regarding key aspects of treatment that include the application of neoadjuvant or perioperative chemo(radio)therapy, an adequate esophagectomy procedure, and a multidisciplinary approach to perioperative care. This narrative review provides an update of literature on these aspects of curative treatment for locally advanced esophageal cancer. Methods: This narrative review included studies by means of searches on PubMed/Embase and Scopus until April 27th, 2025. Key Content and Findings: Evidence is increasing for perioperative FLOT for adenocarcinomas as an alternative, to neoadjuvant chemoradiotherapy, based on the randomized controlled FLOT-4 and ESOPEC trials. For squamous cell carcinoma, the recent NExT trial demonstrated that triplet neoadjuvant chemotherapy achieves the highest overall survival rate at the cost of an increased incidence of febrile neutropenia, as compared to neoadjuvant doublet chemotherapy or neoadjuvant chemoradiotherapy. While still in its global implementation phase, robot-assisted minimally invasive esophagectomy has satisfying outcomes and seems to improve lymph node yield when compared to conventional minimally invasive esophagectomy. Enhanced recovery after surgery (ERAS) protocols can effectively accelerate recovery and reduce length of hospital stay, although literature is not consistent regarding the hypothesized benefits of ERAS parts such as prehabilitation. Conclusions: Recent advancements in multimodality treatment, surgical techniques, and multidisciplinary have positively impacted outcomes for esophageal cancer patients. Future studies are warranted to investigate how survival can be further improved.

KW - esophageal cancer

KW - esophagectomy

KW - robot assisted minimally invasive esophagectomy (RAMIE)

KW - Robotic surgery

UR - https://www.scopus.com/pages/publications/105010333305

U2 - 10.21037/aoe-25-3

DO - 10.21037/aoe-25-3

M3 - Article

AN - SCOPUS:105010333305

VL - 8

JO - Annals of Esophagus

JF - Annals of Esophagus

M1 - 11

ER -

An update on developments in curative treatment for locally advanced esophageal cancer: a narrative review

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

Cite this