Hartwig W, Strobel O, Lordick F, Büchler M W, Werner J
Klinik für Allgemein-, Viszerale- und Transplantationschirurgie, Universität Heidelberg, Heidelberg.
Z Gastroenterol. 2008 Oct;46(10):1207-13. doi: 10.1055/s-2008-1027466. Epub 2008 Oct 20.
Surgery is still the treatment of choice in patients with resectable oesophageal cancer. However, recent randomised controlled trials suggest beneficial effects of adjuvant or neoadjuvant treatment modalities on progression-free and overall survival compared to surgery alone. Neoadjuvant chemoradiotherapy in combination with surgery is most effective in squamous cell carcinomas. Increased perioperative morbidity and mortality should be minimised by surgery in a high-volume centre. In adenocarcinomas of the gastro-oesophageal junction neoadjuvant chemotherapy shows beneficial effects compared to surgery alone. A transhiatal resection should be preferred in distal oesophageal cancer compared to a transthoracic oesophageal resection if the patient is in poor condition. In all other cases a transthoracic resection remains the procedure of choice. Chemoradiotherapy alone is an alternative to surgery in high-risk patients with squamous cell carcinomas of the oesophagus. Therefore the treatment of patients with oesophageal cancer should always include an individualised, multimodal approach including surgery, chemotherapy, and radiotherapy.
手术仍是可切除食管癌患者的首选治疗方法。然而，最近的随机对照试验表明，与单纯手术相比，辅助或新辅助治疗方式对无进展生存期和总生存期有有益影响。新辅助放化疗联合手术对鳞状细胞癌最为有效。高容量中心的手术应尽量减少围手术期发病率和死亡率。在胃食管交界腺癌中，新辅助化疗与单纯手术相比显示出有益效果。如果患者身体状况较差，与经胸食管切除术相比，经裂孔切除术应更适合于远端食管癌。在所有其他情况下，经胸切除术仍是首选手术方式。单纯放化疗是高危食管鳞状细胞癌患者手术的替代方案。因此，食管癌患者的治疗应始终包括个体化的多模式方法，包括手术、化疗和放疗。
