**Preface XI**


Preface

for clinicians but also for researchers.

The esophagus is the long tube running from the back of the mouth to the stomach, and it transports ingested food to the location where real digestion begins. It is a rather simple or‐ gan both structurally and functionally, but can be life threatening once it becomes sick, espe‐ cially when it is malignant. As pointed out in the introductory chapter, "Esophagus and Esophageal Cancer," esophageal cancer kills more than 400,000 people annually and its 5 year survival rate is around 18%. What is even worse, while the incidence of other cancers is declining year after year, esophageal cancer has been moving up steadily for the past several decades, and it casts a really big shadow on the future of human life. Until now there have been no effective drugs to treat esophageal cancer. Most professionals agree that immuno‐ therapy might hold a brighter future in chemotherapy, as demonstrated by the outcomes that have been obtained in several types of cancers. Immunotherapy is a relatively new con‐ cept based on immunological principles to battle against cancers, such as activating and or‐ chestrating B-cells and T-cells to attack tumor cells, introducing specific antibodies to induce tumor cell apoptosis, blocking certain signaling pathways to let the tumor cells die of starva‐ tion, etc. Chapter 2, "Immunotherapy for Esophageal Cancer," gives a thorough review of this topic, including the history of immunotherapy, drugs that are in use as well as those in trials, and mechanisms of functionality of each drug. It is full of useful information not only

While chemotherapy has been making progress, surgical operation has been a common strategy for esophageal cancer patients. To be exact, during surgery the affected esophagus is cut off partially or entirely. Because of the critical location of the organ, however, the suc‐ cess of surgery often depends greatly on the skills of the operating surgeon. For this reason, robots have been brought into the surgical room in recent years. This has been proven to be at least comparable to a skillful surgeon at this point. Chapter 3, "Robotic Esophageal Sur‐ gery for Cancer," tells the story of the actual use of the technology in Germany. Based on experience, this is a promising new way to perform an operation because it can eliminate several human errors. However, a few limitations still exist, such as lack of tactile feedback, longer setup time, and higher overall cost. We believe that these shortcomings can be over‐ come in the near future, as we continue to improve the system. Even with the help from a robot, post-operative complications are still very common. To reduce such unfortunate chances, proper preparations and care are important not just before surgery, but also during and after surgery. Chapter 4, "Prevention and Management of Complications from Esopha‐ gectomy," gives a detailed discussion of this subject, from patient selection to surgeon selec‐ tion, from assessment of the hospital to a blueprint of the surgical procedure, and more. It also provides advice on how to prevent complications before surgery, as well as how to manage complications when they happen. It discusses six types of complications in particu‐
