Surgeryfollowingneoadjuvantchemoradiotherapy(NCRT)isacommonmultidisciplinarytreatmentforresectableesophagealcancer(EC).Afteranalyzing12randomizedcontrolledtrials(RCTs),wediscussthekeyissuesofsurgeryinthemanagementofresectableEC.Alongwithchemoradiotherapy,NCRTisrecommendedforpatientswithsquamouscellcarcinoma(SCC)andadenocarcinoma(AC),andmostchemotherapyregimensarebasedoncisplatin,fluorouracil(FU),orboth(CF).However,taxane-basedschedulesoradditionalstudies,togetherwithnewerchemotherapies,arewarranted.Innineclinicaltrials,post-operativecomplicationsweresimilarwithoutsignificantdifferencesbetweentwotreatmentgroups.In-hospitalmortalitywassignificantlydifferentinonly1outof10trials.HalfoftherandomizedtrialsthatcompareNCRTwithsurgeryinECdemonstrateanincreaseinoverallsurvivalordisease-freesurvival.NCRToffersagreatopportunityformarginnegativeresection,decreaseddiseasestage,andimprovedloco-regionalcontrol.However,NCRTdoesnotaffectthequalityoflifewhencombinedwithesophagectomy.Futuretrialsshouldfocusontheidentificationofoptimumregimensandselectionofpatientswhoaremostlikelytobenefitfromspecifictreatmentoptions.
