Benedix F, Dalicho S F, Stübs P, Schubert D, Bruns C
Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg A.ö.R., Leipziger Str. 44, 39120, Magdeburg, Deutschland,
Chirurg. 2014 Aug;85(8):668-74. doi: 10.1007/s00104-014-2754-6.
Surgery remains the mainstay of potentially curative treatment of esophageal cancer; however, esophageal resection is still associated with a relevant morbidity and mortality. Furthermore, patients frequently suffer from concomitant comorbidities and present in a reduced nutritional status. The rationale of minimally invasive surgery is the reduction of surgical trauma with subsequent minimization of (pulmonary) complications and mortality without compromising oncological quality. Minimally invasive esophageal resection was established nearly two decades ago and since then some centers worldwide have adopted this approach as the preferred option for surgical treatment of esophageal cancer. Minimally invasive esophageal resection can be safely performed and provides excellent results in experienced hands. Currently, there is only one randomized trial available comparing open and minimally invasive resection. It was demonstrated that the latter significantly reduced pulmonary complications with comparable mortality and oncological outcome. However, in the majority of studies these convincing results could not be confirmed. Reduced blood loss and a shortened hospital stay were shown to be the main advantages of the minimally invasive approach. Due to technical modifications, patient selection and a remarkable heterogeneity of current studies, a final conclusion on the value of minimally invasive esophagectomy is difficult to be drawn. Based on the current evidence, a noncritical use of minimally invasive resection for esophageal cancer cannot be recommended; however, in selected patients and with appropriate expertise this approach is at least comparable to open esophagectomy.
手术仍然是食管癌潜在治愈性治疗的主要手段；然而，食管切除术仍伴随着较高的发病率和死亡率。此外，患者常伴有合并症，且营养状况较差。微创手术的基本原理是减少手术创伤，进而将（肺部）并发症和死亡率降至最低，同时不影响肿瘤治疗质量。微创食管切除术于近二十年前确立，自那时起，全球一些中心已将这种方法作为食管癌手术治疗的首选方案。在经验丰富的医生手中，微创食管切除术可以安全地进行，并能取得优异的效果。目前，仅有一项比较开放手术和微创手术的随机试验。结果表明，后者能显著降低肺部并发症，死亡率和肿瘤治疗效果相当。然而，在大多数研究中，这些令人信服的结果并未得到证实。减少失血和缩短住院时间被证明是微创方法的主要优势所在。由于技术改进、患者选择以及当前研究存在显著的异质性，很难就微创食管切除术的价值得出最终结论。基于目前的证据，不建议不加区分地使用微创食管癌切除术；然而，对于特定患者且具备适当专业技能的情况下，这种方法至少与开放食管切除术相当。
