Hong Kong Experiences

The management of esophageal squamous cell carcinoma (ESCC) has evolved significantly, shifting from a generalized approach to a highly individualized one. Historically, surgery was the primary intervention for both curative and palliative intent, often with high mortality. Patients unfit for surgery underwent suboptimal radiotherapy or the endoscopic placement of plastic prostheses. Today, treatment is tailored to the disease stage. Early stage mucosal and submucosal cancers are now effectively resected using endoscopic techniques. For more advanced operable cancers, surgical outcomes have improved dramatically. Refinements in patient selection, anesthesia, perioperative care, and surgical technique have reduced esophagectomy mortality to minimal levels. Furthermore, minimally invasive approaches have largely replaced open surgery, resulting in fewer postoperative complications. These improvements are enhanced by ERAS (Enhanced Recovery After Surgery) protocols, which facilitate a better recovery experience. The routine integration of multimodality therapy has also improved long-term survival. For palliative care, more advanced options are available including self-expanding metallic stents (SEMS), chemotherapy, radiotherapy, and immunotherapy. This text outlines the corresponding evolution in treatment strategies at The University of Hong Kong over recent decades. Despite these advances, many challenges in ESCC treatment remain unresolved. Ongoing research is crucial to further improving the prognosis for these patients.