1) Management Framework (Pre-operative Assessment)

All patients should be initially assessed to determine operability. This will require complete staging as described in the previous section. Curative therapy is rarely possible with distant metastases, nodal metastases, and involvement of contiguous structures. In addition, co-morbid illness, general status of the patient, or advanced age may preclude surgery even in potentially resectable disease.

2) Tertiary Triage Criteria

Mortality rates for esophagectomy, either total or subtotal, should be lower than 5% with morbidity ranging from 10-30%. Best results are achieved in surgical units with familiarity in managing esophageal cancer. For patients with potentially resectable disease, referral to a centre with experience in esophageal resections is recommended.