Optimization of surgical esophageal cancer treatment

The present thesis contributes to the optimization of esophageal cancer care. It addresses the heterogeneity in the classification systems for categorization of lymph node metastases and the history and evidence for the state of the art of lymphadenectomy. Furthermore, recurrence and survival of esophageal cancer patients after curative intent treatment is investigated, as well as long-term postoperative quality of life. Finally, the study protocol of two ongoing studies are presented. First the protocol of the TIGER-SQA study, this study aims to develop and utilize a surgical quality assessment tool to examine the extent of lymphadenectomy during esophagectomy for esophageal cancer, within TIGER study. Finally, the protocol of the in short USPIO-enhanced MRI study will be presented. This study aims to develop a fundamentally different MRI approach to achieve high-resolution abdominal and/or thoracic tumor imaging and visualization of lymph node metastases. Additionally, it evaluates the accuracy of imaging lymph node metastases by making use of ultrasmall superparamagnetic iron oxide nanoparticles (USPIO) in MRI compared to the current imaging techniques in patients treated with curative intent for a distal esophageal adenocarcinoma.