Cools-Lartigue Jonathan, Spicer Jonathan, Ferri Lorenzo E
Department of Surgery, McGill University Health Center, Montreal, QC, Canada,
J Gastrointest Surg. 2015 May;19(5):964-72. doi: 10.1007/s11605-014-2701-3. Epub 2015 Feb 4.
The objective of this study is to outline the evidence regarding the surgical management of esophageal cancer and provide a single institutional outline regarding its implementation.
Esophageal cancer is a major cause of cancer-related morbidity and mortality worldwide. Surgery continues to play an important role in its management and offers the best chance for cure in localized and locally advanced disease. However, considerable controversy exists regarding the optimum treatment strategy in this patient population. Furthermore, despite advances in operative and perioperative care and the advent of minimally invasive approaches, the majority of patients succumb to distant metastases after curative intent resection. This failure highlights the importance of multimodal, stage-directed therapy in the management of patients with newly diagnosed esophageal tumors.
Herein, we provide a comprehensive, evidence-based review of the diagnostic workup and locoregional and systemic treatment options available to esophageal cancer patients. The evidence supporting perioperative chemotherapy versus chemoradiotherapy is outlined and discussed. In addition, we highlight our institutional approach to the diagnostic evaluation, operative selection strategy, and perioperative treatment regimen selection based on the stage of presentation. Finally, we discuss the role of enhanced recovery in the postoperative management of this complex group of patients.
Esophageal cancer remains a devastating disease with high mortality. Favorable outcomes mandate a multimodal, stage-directed treatment approach.
本研究的目的是概述有关食管癌手术治疗的证据，并提供一份关于其实施的单一机构概述。
食管癌是全球癌症相关发病率和死亡率的主要原因。手术在其治疗中继续发挥重要作用，为局限性和局部晚期疾病提供了最佳治愈机会。然而，对于该患者群体的最佳治疗策略存在相当大的争议。此外，尽管手术和围手术期护理取得了进展，以及微创方法的出现，但大多数患者在根治性切除术后仍死于远处转移。这种失败凸显了多模式、分期导向治疗在新诊断食管癌患者管理中的重要性。
在此，我们对食管癌患者可用的诊断检查以及局部和全身治疗选择进行了全面的、基于证据的综述。概述并讨论了支持围手术期化疗与放化疗的证据。此外，我们强调了我们基于表现阶段的诊断评估、手术选择策略和围手术期治疗方案选择的机构方法。最后，我们讨论了加速康复在这一复杂患者群体术后管理中的作用。
食管癌仍然是一种具有高死亡率的毁灭性疾病。良好的结果需要多模式、分期导向的治疗方法。
