Korean Experiences

In Korea, esophageal squamous cell carcinoma (ESCC)—a distinct oncologic entity—is characterized by a relatively low incidence, predominant squamous histology, and male sex. Earlier diagnosis, facilitated by nationwide cancer screening programs and universal healthcare coverage, contributes to improved survival rates. Diagnosis and staging require esophagogastroduodenoscopy, endoscopic ultrasound, computed tomography (CT), and positron emission tomography-CT. For superficial ESCC, endoscopic resection—particularly endoscopic submucosal dissection—is a preferred organ-preserving treatment, with selected patients having comparable long-term outcomes as for esophagectomy. Surgical treatment, predominantly performed at metropolitan areas’ high-volume centers, has progressively changed toward minimally invasive techniques, particularly robot-assisted thoracoscopic esophagectomy, with improved postoperative outcomes. Lymphadenectomy extent varies across institutions, though two-field dissection remains standard, with selective three-field approaches in specific contexts. Korea’s unique healthcare infrastructure and centralized surgical expertise showed distinctive treatment patterns and evolving therapeutic strategies. Definitive chemoradiation, commonly 5-fluorouracil and cisplatin or CROSS regimen (weekly paclitaxel and carboplatin), remains the treatment cornerstone for unresectable or medically inoperable disease. Neoadjuvant therapy, including DCF (docetaxel, cisplatin, and 5-fluorouracil) chemotherapy and concurrent chemoradiotherapy, is increasingly adopted for locally advanced cases, with growing interest in integrated immunotherapy. Ongoing clinical trials and novel systemic agent integration may further refine Korea’s ESCC multidisciplinary management.