Law Simon
Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong SAR, China.
Best Pract Res Clin Gastroenterol. 2006;20(5):925-40. doi: 10.1016/j.bpg.2006.03.011.
Innovative minimally invasive surgical (MIS) techniques have been explored for the purpose of oesophagectomy since the early 1990s, including various combinations of thoracoscopy, laparoscopy or laparoscopic-assisted methods, mediastinoscopy and open thoracotomy and laparotomy. The myriad of surgical approaches implies a lack of consensus on which is superior. Like open surgery, it is perhaps more important to have a tailored approach for the individual patient. MIS oesophagectomy has been shown to be feasible, and at least equivalent postoperative morbidity and mortality rates to open surgical resection have been demonstrated. Selected series have achieved less blood loss, reduction in some postoperative complications, decrease in intensive care and hospital stay, and better preservation of pulmonary function. Clear proof of superiority over conventional oesophagectomy methods however is not forthcoming since comparisons were often made with unmatched patient cohorts, and a well conducted randomized controlled trial has not been carried out. It is expected that with further improvements in instrumentation and experience, these difficult procedures may become more accessible and widely practised.
自20世纪90年代初以来，人们一直在探索创新的微创外科（MIS）技术用于食管癌切除术，包括胸腔镜、腹腔镜或腹腔镜辅助方法、纵隔镜以及开胸手术和开腹手术的各种组合。众多的手术方法意味着对于哪种方法更优越缺乏共识。与开放手术一样，为个体患者量身定制手术方法可能更为重要。微创食管癌切除术已被证明是可行的，并且已证明其术后发病率和死亡率至少与开放手术切除相当。部分系列研究显示出血量减少、一些术后并发症减少、重症监护和住院时间缩短以及肺功能得到更好的保留。然而，由于常常是与不匹配的患者队列进行比较，且尚未开展一项精心设计的随机对照试验，因此尚无明确证据表明其优于传统食管癌切除方法。预计随着器械的进一步改进和经验的积累，这些复杂的手术可能会更容易开展并得到更广泛的应用。
