Watson Thomas J
Division of Thoracic and Foregut Surgery, Department of Surgery, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA.
Semin Thorac Cardiovasc Surg. 2008 Winter;20(4):310-9. doi: 10.1053/j.semtcvs.2008.11.001.
The incidence of esophageal adenocarcinoma continues to rise in the United States and Western Europe. With the introduction of screening and surveillance programs for Barrett's esophagus, the precursor of esophageal adenocarcinoma, early esophageal neoplasia is being recognized on an increasing basis. Esophagectomy is the current standard of care for patients found to have Barrett's esophagus with high-grade dysplasia or intramucosal carcinoma and determined to be at suitable risk for surgical intervention. The role of esophagectomy in such circumstances has been questioned, however, due to concerns of excessive operative morbidity or mortality and the potential for a negative impact on long-term quality of life. Endoscopic resection has been introduced as a means to stage early esophageal neoplasms and as curative therapy for mucosal tumors determined to be low risk for nodal metastasis or systemic spread, allowing preservation of the esophagus. This article reviews endoscopic resection for the management of early esophageal neoplasia, including preprocedural evaluation, appropriate patient selection, available techniques and results of recent clinical trials.
在美国和西欧，食管腺癌的发病率持续上升。随着针对食管腺癌的前驱病变——巴雷特食管的筛查和监测项目的引入，早期食管肿瘤越来越多地被发现。对于被诊断为高级别异型增生或黏膜内癌的巴雷特食管患者，且被判定具有适合手术干预风险的患者，食管切除术是目前的标准治疗方法。然而，由于担心手术发病率或死亡率过高以及对长期生活质量可能产生负面影响，食管切除术在这种情况下的作用受到了质疑。内镜切除术已被引入，作为对早期食管肿瘤进行分期的手段，以及作为对确定为淋巴结转移或全身扩散低风险的黏膜肿瘤的根治性治疗方法，从而保留食管。本文综述了内镜切除术在早期食管肿瘤治疗中的应用，包括术前评估、合适的患者选择、可用技术以及近期临床试验的结果。
