Gockel I, Lorenz D
Klinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
Klinik für Allgemein- und Viszeralchirurgie, Sana Klinikum Offenbach GmbH, Offenbach, Deutschland.
Chirurg. 2017 Jun;88(6):496-502. doi: 10.1007/s00104-016-0364-1.
Minimally invasive resections are increasingly employed in oncologic surgery for esophageal carcinoma. The new German S3 guideline states that esophagectomy, as well as reconstruction of the esophagus, can be performed minimally invasively or in combination with open techniques (hybrid). However, the current value of different techniques - ranging from complete minimally invasive esophagectomy over hybrid to robotic surgery - remains unregarded.This review provides a critical comparison of these techniques based on current evidence. Minimally invasive procedures of oncologic esophageal resection are safe in experienced hands and show numerous advantages with regard to postoperative reconvalescence. Laparoscopic gastrolysis with intra-abdominal lymphadenectomy and muscle sparing as well as anterolateral mini-thoracotomy (also via VATS as single-port technique) as a hybrid method also result in a relevant reduction of postoperative mortality and offer the possibility of extended mediastinal lymphadenectomy, which requires a high level of expertise when performed thoracoscopically. At present, robotic esophagectomy is applied in only a few clinics in Germany. A lack of evidence based on studies for esophageal surgery, as well as high acquisition and operating costs of the robotic system, have to be taken into account.
微创切除术在食管癌的肿瘤外科手术中应用越来越广泛。新的德国S3指南指出，食管切除术以及食管重建可以通过微创方式进行，也可以与开放技术（混合手术）相结合。然而，从完全微创食管切除术到混合手术再到机器人手术等不同技术的当前价值仍未得到重视。本综述基于现有证据对这些技术进行了批判性比较。肿瘤性食管切除的微创操作在经验丰富的医生手中是安全的，并且在术后康复方面具有诸多优势。腹腔镜下胃松解术联合腹腔内淋巴结清扫和保留肌肉，以及作为混合手术方法的前外侧小切口开胸术（也可通过单孔技术的电视辅助胸腔镜手术进行），也能显著降低术后死亡率，并提供扩大纵隔淋巴结清扫的可能性，而胸腔镜下进行该操作需要高水平的专业技能。目前，机器人食管切除术在德国仅在少数几家诊所应用。必须考虑到缺乏针对食管手术的研究证据，以及机器人系统的高昂购置和操作成本。
