Gastinger I
Chirurgische Klinik, Carl-Thiem-Klinikum, Thiem-Strasse 111, 03048, Cottbus, Germany.
Chirurg. 2008 Jan;79(1):61-5. doi: 10.1007/s00104-007-1402-9.
The central element of the multimodal therapy concept for esophageal carcinomas is operative resection. This is a complex visceral surgical intervention that calls for standardized and interdisciplinary perioperative management. Continuous control of results is essential for evaluating therapy concepts.
Data of patients who had undergone thoracoabdominal resection of an esophageal carcinoma were recorded and evaluated in a prospective single center study within the framework of internal quality control.
In the time span between 1 January 1997 and 31 December 2005, 193 patients with esophageal carcinoma were treated. Of these, 97 (50.7%) received single-stage abdominothoracal resection without neoadjuvant primary therapy. In 70% of these cases, an advanced tumor stage was present (UICC IIb or higher). R0 resection was achieved in 83 patients (85.5%). The rate of hospital mortality was found to be 6.2% (n=6). In a follow-up examination rate of 95.6%, an overall 5-year survival rate of 25% was found for all resected patients and 30% for those who received curative resection.
The long-term results reached by surgery alone are comparable to those published in the current literature but are still not satisfying. A more individual approach to therapy with increased selection of patients for the application of modern neoadjuvant concepts could lead to an improvement in prognosis.
食管癌多模式治疗理念的核心要素是手术切除。这是一项复杂的内脏外科手术，需要标准化和跨学科的围手术期管理。持续控制结果对于评估治疗理念至关重要。
在内部质量控制框架下的一项前瞻性单中心研究中，记录并评估了接受胸腹联合食管癌切除术患者的数据。
在1997年1月1日至2005年12月31日期间，对193例食管癌患者进行了治疗。其中，97例（50.7%）接受了一期胸腹联合切除术，未进行新辅助初始治疗。在这些病例中，70%存在晚期肿瘤分期（国际抗癌联盟IIb期或更高）。83例（85.5%）实现了R0切除。医院死亡率为6.2%（n = 6）。在95.6%的随访检查率中，所有切除患者的总体5年生存率为25%，接受根治性切除的患者为30%。
单纯手术所达到的长期结果与当前文献中发表的结果相当，但仍不尽人意。采用更个体化的治疗方法，增加选择应用现代新辅助理念的患者，可能会改善预后。
