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食管癌的微创外科治疗:文献回顾与机构经验

Minimally invasive surgery for esophageal cancer: review of the literature and institutional experience.

机构信息

Gastrointestinal Tumor Program, H Lee Moffitt Cancer Center, Tampa, FL 33612, USA.

出版信息

Cancer Control. 2013 Apr;20(2):130-7. doi: 10.1177/107327481302000206.

Abstract

BACKGROUND

Esophageal cancer represents a major public health problem in the world. Several minimally invasive esophagectomy (MIE) techniques have been described and represent a safe alternative for the surgical management of esophageal cancer in selected centers with high volume and surgeons experienced in minimally invasive procedures.

METHODS

The authors reviewed the most recent and largest studies published in the medical literature that reported the outcomes for MIE techniques.

RESULTS

In larger series, MIE has proven to be equivalent in postoperative morbidity and mortality to the open esophagectomy. However, MIE has been associated with less blood loss, reduced postoperative pain, decreased time in the intensive care unit, and shortened length of hospital stay compared with the conventional open approaches. Despite limited data, no significant difference in survival stage for stage has been observed between open esophagectomy and MIE.

CONCLUSIONS

The myriad of MIE techniques complicates the debate for defining the optimal surgical approach for the treatment of esophageal cancer. Randomized controlled trials comparing MIE with conventional open esophagectomy are needed to clarify the ideal procedure with the lowest postoperative morbidity, best quality of life after surgery, and long-term survival.

摘要

背景

食管癌是全球主要的公共卫生问题。几种微创食管切除术(MIE)技术已经被描述,并且在高容量和经验丰富的微创外科医生的选定中心,代表了食管癌手术治疗的一种安全替代方法。

方法

作者回顾了医学文献中报道 MIE 技术结果的最新和最大的研究。

结果

在更大的系列中,MIE 在术后发病率和死亡率方面与开放性食管切除术相当。然而,与传统的开放性方法相比,MIE 与较少的出血量、减轻的术后疼痛、减少重症监护病房的时间和缩短住院时间相关。尽管数据有限,但在开放性食管切除术和 MIE 之间并未观察到生存阶段的生存差异。

结论

微创食管切除术的多种技术使得定义治疗食管癌的最佳手术方法的争论变得复杂。需要进行比较 MIE 与传统开放性食管切除术的随机对照试验,以明确术后发病率最低、术后生活质量最佳和长期生存的理想手术方法。

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