McLaren Patrick J, Dolan James P
Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, 3181 Sam Jackson Park Rd., Portland, OR, 97239, USA.
World J Surg. 2017 Jul;41(7):1712-1718. doi: 10.1007/s00268-017-3958-y.
The treatment of early-stage esophageal cancer and high-grade dysplasia of the esophagus has changed significantly in recent years. Many early tumors that were traditionally treated with esophagectomy can now be resected with endoscopic therapy alone. These new endoscopic modalities can offer similar survival outcomes without the associated morbidity of a major operation. However, a number of these cases may still require surgical intervention as the best treatment option.
The current scientific literature, national and international guidelines were reviewed for recommendations regarding optimal treatment of early esophageal malignancy.
The primary advantage of surgery over endoscopic treatment lies in the reduced risk of recurrence as well as the ability to assess harvested lymph nodes for regional disease. We recommend that esophageal tumors that have invaded into the submucosa (T1b) or beyond should be treated with an esophagectomy. In addition, dysplastic lesions and cancers that demonstrate poorly differentiated pathology or lymphovascular or perineural invasion should be surgically resected. Finally, large tumors, multifocal lesions, tumors within a long segment of Barrett's esophagus, tumors adjacent to a hiatal hernia, tumors that cannot be resected enbloc with endoscopic techniques should also be treated with an esophagectomy.
When performed at high-volume centers in experienced hands, esophagectomy can have consistently good outcomes for high-grade dysplasia and early esophageal cancers, and should be considered as a treatment option.
近年来，早期食管癌和食管高级别异型增生的治疗发生了显著变化。许多传统上采用食管切除术治疗的早期肿瘤现在仅通过内镜治疗即可切除。这些新的内镜治疗方法可以提供相似的生存结果，且无大手术相关的发病率。然而，其中一些病例可能仍需要手术干预作为最佳治疗选择。
回顾当前的科学文献、国内和国际指南，以获取关于早期食管恶性肿瘤最佳治疗的建议。
手术相对于内镜治疗的主要优势在于复发风险降低，以及能够评估切除的淋巴结是否存在区域疾病。我们建议，侵犯至黏膜下层（T1b）或更深层的食管肿瘤应采用食管切除术治疗。此外，显示病理分化差或存在淋巴血管或神经周围侵犯的异型增生病变和癌症应进行手术切除。最后，大肿瘤、多灶性病变、巴雷特食管长段内的肿瘤、与食管裂孔疝相邻的肿瘤、无法通过内镜技术整块切除的肿瘤也应采用食管切除术治疗。
在经验丰富的医生操作的高容量中心进行食管切除术时，对于高级别异型增生和早期食管癌可始终取得良好的治疗效果，应将其视为一种治疗选择。
