Hong Kong Experiences of the Treatment of Esophageal Squamous Cell Carcinoma

Abstract

Treatment of squamous cell carcinoma of the esophagus (ESCC) has evolved over the years. In the past, surgery was performed for patients with potential for cure as well as those for palliation only. Endoscopic placement of plastic prosthesis was used for those unfit for surgery, and the results of radiotherapy were suboptimal. Management of ESCC has become more individualized. Early mucosal/submucosal cancers can be resected by endoscopic methods. For more advanced cancers, results of surgery have improved. Through better patient selection, refinement of anesthetic, perioperative care, and surgical technique, esophagectomy can be carried out with minimal mortality. Minimally invasive approaches have replaced traditional open surgery and result in fewer morbidities. Enhanced Recovery After Surgery (ERAS) programs have led to better recovery experiences after esophagectomy. Integration of multimodality treatment strategies is routine, with improved in long-term outcome. For palliation, better endoscopic methods such as insertion of self-expanding metallic stents (SEMS), chemotherapy, radiotherapy, and even immunotherapy are utilized. The changes in treatment strategies at The University of Hong Kong over the past decades are outlined. However, many issues remain unanswered in treating ESCC and it is hoped that through research, the prognosis of these unfortunate patients will continue to improve.