Being diagnosed with esophageal cancer can be overwhelming, and choosing the right treatment is one of the biggest decisions patients and their healthcare team face. For some people, treatment may include chemotherapy and radiation alone, while others also have surgery to remove part or all of the esophagus. A large new study suggests that, for many patients with resectable esophageal cancer, adding surgery to treatment may lead to better survival than chemotherapy and radiation alone. However, treatment decisions are highly individualized, and not every patient is a candidate for surgery.
What Is Esophageal Cancer?
Esophageal cancer develops in the tube that carries food from the mouth to the stomach. The two most common types are:
- Adenocarcinoma, which usually develops in the lower part of the esophagus.
- Squamous cell carcinoma, which is more common in the upper and middle portions of the esophagus.
Treatment depends on several factors, including:
- The stage of the cancer
- The type of tumor
- Whether it can be safely removed with surgery
- The patient’s overall health
For many patients with localized disease, doctors use a combination of chemotherapy, radiation therapy, and surgery.
What Did the Study Find?
Researchers analyzed information from 59,754 patients with esophageal cancer treated between 2004 and 2020 using the National Cancer Institute’s SEER database.
Of those patients:
- About 21% underwent surgery.
- About 79% did not undergo surgery.
- Researchers compared patients treated with definitive chemoradiation (chemotherapy and radiation without surgery) with those who received chemoradiation followed by surgery.
The researchers found that patients treated with chemotherapy and radiation without surgery had a significantly higher risk of death than those who also had surgery.
The Benefit Was Seen Across Many Groups
One of the strengths of the study was that the researchers looked at many different patient groups.
They found a survival benefit with surgery:
- In both major types of esophageal cancer.
- In patients with earlier-stage, potentially removable tumors.
- Across multiple overall cancer stages.
- Even among patients who were considered healthy enough for surgery but chose not to have it.
The findings suggest that surgery remained associated with better survival in many situations where it was an option.
Why Might Surgery Improve Survival?
Chemotherapy and radiation can shrink or destroy cancer cells, but they may not eliminate every remaining cancer cell.
Surgery offers another opportunity to remove:
- The remaining tumor.
- Nearby tissue that may contain cancer cells.
- Lymph nodes where cancer may have spread.
For medically fit patients with tumors that can be removed, combining surgery with other treatments may improve long-term outcomes by reducing the amount of cancer left behind.
Does This Mean Everyone Should Have Surgery?
No. It depends on your health care provider’s evaluation.
Not every person with esophageal cancer is a candidate for surgery. Some tumors cannot be safely removed, and some patients have other medical conditions that make major surgery too risky.
Treatment decisions should consider:
- The stage of the cancer.
- The tumor’s location.
- The patient’s overall health.
- Personal preferences.
- Recommendations from a multidisciplinary cancer team.
The authors also note that this was a retrospective study, meaning it looked back at existing patient records rather than randomly assigning treatments. Because of this, the study cannot prove that surgery alone caused the improved survival, although the findings were consistent across many different analyses.
What This Means for You
This large study suggests that surgery continues to play an important role in treating many patients with resectable esophageal cancer. For patients who are healthy enough for surgery and whose cancer can be removed, combining surgery with chemotherapy and radiation was associated with better survival than chemotherapy and radiation alone.
If you or a loved one has been diagnosed with esophageal cancer, it’s important to discuss all treatment options with your cancer care team. Every case is different, and the best treatment plan depends on the individual patient, the type of cancer, and how far it has spread.
Source
- Housman B, Gulati S, Kulshrestha A, Untalan M, Ivic-Pavlicic T, Tuminello S, et al. Stop Canceling Surgery for Esophageal Cancer: An Analysis of Treatment Related Mortality in 60 000 Patients. J Surg Oncol. 2025;132:977-986. Available from: https://doi.org/10.1002/jso.70085. Accessed by: https://onlinelibrary.wiley.com/doi/10.1002/jso.70085.
