Bonavina Luigi, Asti Emanuele, Sironi Andrea, Bernardi Daniele, Aiolfi Alberto
Division of General Surgery, Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy.
J Thorac Dis. 2017 Jul;9(Suppl 8):S761-S772. doi: 10.21037/jtd.2017.06.55.
Esophagectomy is a major surgical procedure associated with a significant risk of morbidity and mortality. Minimally invasive esophagectomy is becoming the preferred approach because of the potential to limit surgical trauma, reduce respiratory complications, and promote earlier functional recovery. Various hybrid and total minimally invasive surgical techniques have been introduced in clinical practice over the past 20 years, and minimally invasive esophagectomy has been shown equivalent to open surgery concerning the short-term outcomes. Implementation of a minimally invasive esophagectomy program is technically demanding and requires a significant learning curve and the infrastructure of a dedicated multidisciplinary center where optimal staging, individualized therapy, and perioperative care can be provided to the patient. Both hybrid and total minimally invasive techniques of esophagectomy have proven safe and effective in expert centers. The choice of the surgical approach should be driven by preoperative staging, tumor site and histology, comorbidity, patient's anatomy and physiological status, and surgeon's experience.
食管切除术是一种主要的外科手术，具有较高的发病和死亡风险。由于微创食管切除术有可能限制手术创伤、减少呼吸并发症并促进早期功能恢复，它正成为首选的手术方式。在过去20年里，各种杂交和完全微创外科技术已被引入临床实践，并且微创食管切除术在短期疗效方面已被证明与开放手术相当。实施微创食管切除术计划在技术上要求很高，需要显著的学习曲线以及一个专门的多学科中心的基础设施，在该中心能够为患者提供最佳的分期、个体化治疗和围手术期护理。食管切除术的杂交和完全微创技术在专家中心均已被证明是安全有效的。手术方式的选择应根据术前分期、肿瘤部位和组织学、合并症、患者的解剖结构和生理状况以及外科医生的经验来决定。
