GASTROINTESTINAL TRACT: Edited by Alain Hendlisz and Francesco SclafaniThinking through the multimodal treatment of localized oesophageal cancer: the point of view of the surgeonPucher, Philip H.a,b; Wijnhoven, Bas P.L.c; Underwood, Timothy J.d; Reynolds, John V.e; Davies, Andrew R.a,fAuthor Information aDepartment of Surgery, Guy's and St Thomas’ NHS Foundation Trust, London bDepartment of Surgery, Portsmouth University Hospitals NHS Trust, Portsmouth, UK cDepartment of Surgery, Erasmus MC-Erasmus University Medical Centre, Rotterdam, The Netherlands dSchool of Cancer Sciences, Faculty of Medicine, University of Southampton, UK eDepartment of Surgery, National Oesophageal and Gastric Center, St. James's Hospital and Trinity College, Dublin, Ireland fKing's College London, London, UK Correspondence to Andrew R. Davies, Consultant Upper GI Surgeon, Department of Surgery, Guys and St Thomas’ NHS Foundation Trust, London. E-mail: [email protected] Current Opinion in Oncology: July 2021 - Volume 33 - Issue 4 - p 353-361 doi: 10.1097/CCO.0000000000000751 Buy Metrics Abstract Purpose of review This review examines current developments and controversies in the multimodal management of oesophageal cancer, with an emphasis on surgical dilemmas and outcomes from the surgeon's perspective. Recent findings Despite the advancement of oncological neoadjuvant treatments, there is still no consensus on what regimen is superior. The majority of patients may still fail to respond to neoadjuvant therapy and suffer potential harm without any survival advantage as a result. In patients who do not respond, adjuvant therapy is still often recommended after surgery despite any evidence for its benefit. We examine the implications of different regimens and treatment approaches for both squamous cell cancer and adenocarcinoma of the oesophagus. Summary The efficacy of neoadjuvant treatment is highly variable and likely relates to variability of tumour biology. Ongoing work to identify responders, or optimize treatment on an individual patient, should increase the efficacy of multimodal therapy and improve patient outcomes. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.