Bremner R M, DeMeester T R
Department of Surgery, University of Southern California School of Medicine, Los Angeles.
Gastroenterol Clin North Am. 1991 Dec;20(4):743-63.
The view of surgical treatment of esophageal carcinoma is pessimistic. This is so because (1) most patients present late in the disease and are beyond the benefits of surgical therapy for cure, (2) resection is associated with a high operative mortality, and (3) the poor 5-year survival rates for surgical resection cited in the literature are poor, although these rates may include procedures done for palliation and not for survival. Early disease is potentially curable. With a better understanding of the biology of the tumor and with improved staging techniques, patients who are able to undergo an en bloc resection designed for cure according to the classic principles of surgical oncology are selected. Five-year survival rates for curative en bloc resections range from 40% to 50%. For patients unable to undergo a curative resection, esophagectomy with esophagogastrostomy offers the best palliation. Transhiatal esophagectomy performed through an abdominal and cervical incision is an appropriate palliative procedure for tumors located in the lower third and cervical portions of the esophagus. The standard esophagectomy using a right thoracotomy is the preferred technique for a palliative resection of tumors located in the upper and midthoracic esophagus. Unresectable tumors may be palliated by intubation and, in some specific situations, surgical bypass.
食管癌的外科治疗前景不容乐观。原因如下：（1）大多数患者就诊时疾病已处于晚期，无法从旨在治愈的手术治疗中获益；（2）手术切除伴随着较高的手术死亡率；（3）文献中所引用的手术切除后的5年生存率较低，尽管这些生存率可能包括了为缓解症状而非为延长生存期所做的手术。早期疾病有可能治愈。随着对肿瘤生物学的更好理解以及分期技术的改进，可根据外科肿瘤学的经典原则选择能够接受旨在治愈的整块切除的患者。根治性整块切除的5年生存率在40%至50%之间。对于无法接受根治性切除的患者，食管胃吻合术式的食管切除术可提供最佳的缓解症状效果。经腹和颈部切口进行的经裂孔食管切除术是治疗位于食管下三分之一段和颈部的肿瘤的合适姑息性手术。采用右胸切口的标准食管切除术是对上段和中段食管癌进行姑息性切除的首选技术。无法切除的肿瘤可通过插管以及在某些特定情况下通过手术旁路进行姑息治疗。
