Oesophageal cancer awareness month 2026

To mark Oesophageal Cancer Awareness Month 2026, we have brought together a selection of recent high-impact papers from BJS and BJS Open that showcase advances in oesophageal and oesophagogastric junction cancer research. These studies span surgical innovation, trial methodology, international outcomes benchmarking, treatment strategy, and intraoperative decision-making. Together, they highlight both progress and ongoing challenges — from evaluating robot-assisted oesophagectomy and questioning surrogate trial endpoints, to improving conduit perfusion assessment and refining margin control. This curated set of highlights reflects the breadth of current evidence shaping modern oesophageal cancer care.

______

______

Robot-assisted minimally invasive oesophagectomy (RAMIO) is being adopted rapidly in oesophageal cancer surgery, but robust evaluation has lagged behind clinical uptake. This systematic review of 104 studies (133,107 patients) shows that most evidence sits at IDEAL stage 2B, with only four RCTs and limited high-quality long-term data. While RCTs suggest fewer complications and faster recovery with RAMIO, long-term outcomes remain uncertain and are often at risk of bias. Overall, RAMIO appears promising, but its future depends on better-designed, IDEAL-guided trials and standardized reporting to define its true value. Read paper.

______

Pathological complete response (pCR) is often used as an early endpoint in oesophageal cancer trials, but its value as a surrogate for overall survival (OS) remains uncertain. In this individual patient data analysis of 10 phase III trials (1,641 patients), pCR was associated with better survival, especially after neoadjuvant chemotherapy, but the correlation with OS was weak and far below accepted thresholds for surrogacy. Even with neoadjuvant chemoradiotherapy—where pCR rates were higher—pCR failed to reliably predict long-term survival. These findings show that pCR should not be used as a surrogate endpoint for OS in resectable oesophageal cancer, reinforcing the need for trials with robust survival follow-up. Read paper.

______

How comparable are oesophagectomy outcomes across countries?

Using two nationwide audits from Japan and the Netherlands (over 14,000 patients), this study compared patient characteristics, surgical approaches, and short-term outcomes after oesophagectomy. Despite major differences in case mix—squamous cell carcinoma and cervical anastomosis predominating in Japan, adenocarcinoma and intrathoracic anastomosis in the Netherlands—overall complication rates were remarkably similar. Thirty-day mortality was low in both countries (0.8% Japan vs 2.7% Netherlands), while pneumonia and anastomotic leakage remained the most frequent complications. Minimally invasive surgery reduced pneumonia risk in the Dutch cohort but not in Japan, and cervical anastomosis consistently increased leakage risk in both settings. These findings highlight that national context, patient profiles, and surgical traditions matter when interpreting international studies—and that benchmarking outcomes requires more than simply comparing techniques. Read paper.

______

______

Anastomotic leakage remains a major cause of morbidity after oesophagectomy, with inadequate conduit perfusion playing a central role. In this prospective study of 100 patients, quantitative intraoperative assessment of gastric conduit perfusion using indocyanine green fluorescence angiography demonstrated significantly lower fluorescence intensity at the anastomotic site in patients who developed leakage. Fluorescence intensity ≤90% and upper oesophageal tumour location were independently associated with an increased risk of anastomotic leakage. These findings support the clinical utility of objective, quantitative ICG fluorescence metrics to guide anastomotic site selection and potentially reduce postoperative leakage rates. Read paper.

______

In this large multicentre cohort study from the UK and Ireland, treatment patterns and outcomes for locally advanced oesophageal squamous cell carcinoma were evaluated in a Western population where the disease is relatively uncommon. Despite most patients receiving definitive chemoradiotherapy, neoadjuvant chemoradiotherapy followed by surgery was associated with substantially longer survival compared with definitive chemoradiotherapy or neoadjuvant chemotherapy plus surgery. These survival advantages persisted after propensity score matching, suggesting a robust benefit in appropriately selected patients. In the absence of adequately powered Western randomized trials, the findings support neoadjuvant chemoradiotherapy plus surgery as the preferred curative strategy for fit patients. Read paper.

______

This retrospective study investigated the oncological significance of unexpected horizontal tumour spread in oesophagogastric junction adenocarcinoma by quantifying discrepancies between gross and pathological resection margins. Patients with extended proximal and/or distal microscopic spread had significantly worse recurrence-free and overall survival, with the poorest outcomes observed when both margins were involved. Unexpected horizontal spread was independently associated with recurrence and mortality, particularly in patients with proximal OGJ tumours or clinical lymph node metastasis. These findings highlight the importance of meticulous intraoperative margin assessment and support the use of frozen section analysis to guide additional resection in high-risk patients. Read paper.