This review article aims to discuss the modalities of oesophageal resection, to define the categories of patients who are most likely to benefit from oesophagectomy with extensive lymph node clearance, and to analyse the eventual contribution of nonsurgical neo-adjuvant or adjuvant
therapies to improving long-term survival rates achieved by surgery alone. Both the review of the literature devoted to potentially curative treatment of oesophageal
cancer and the authors' own experience indicate that resection of the oesophageal tube en bloc with the locoregional lymph nodes provides patients with the best chance of long-term survival and cure. This is true, even though some of the resected lymph nodes are metastatic. Most phase III comparative studies fail to shown any overall survival improvement following multimodal
therapy in comparison with surgery alone, so that there is now no scientific reason for systematic addition of radio- and/or
chemotherapy to extensive surgery in potentially resectable
neoplastic processes. However, neo-adjuvant radio- and/or
chemotherapy is indicated in suspected non-resectable T4
tumors for downstaging and subsequent oesophageal resection in good responders. The benefit in terms of long-term survival and cure that can be expected from adjuvant chemo- and/or
radiotherapy after radical resection of a neoplastic process having already spread into a large number of loco-regional lymph node requires objective evaluation by prospective, randomized studies.