Management of early esophageal cancer

The advent of endoscopic therapy has revolutionized the treatment of early-stage esophageal adenocarcinoma with favorable safety outcomes compared with esophagectomy, while providing similar oncological outcomes in appropriately selected patients. At the same time, minimally invasive esophagectomy has been more frequently utilized as an alternative to traditional open esophagectomy with fewer complications but requires surgical expertise. A limitation of endotherapy is the inability to assess for lymph node metastases that would imply a higher risk of incomplete treatment compared with esophagectomy. To recommend the most appropriate treatment for early-stage esophageal adenocarcinoma, clinicians must carefully evaluate several factors such as patients' health status, depth of tumor invasion, severity of underlying reflux disease and esophageal function, and risk factors for nodal metastases. This requires expertise on the part of the endoscopist and a thorough knowledge of the pros and cons of endotherapy. These patients have highly curable cancers, and the ultimate goal should be to maximize long-term survival with good quality of life.