Achim Florin, Constantinoiu Silviu
Chirurgia (Bucur). 2018 Jan-Feb;113(1):19-37. doi: 10.21614/chirurgia.113.1.19.
The treatment of esophageal cancer has become more effective due to advances in surgical techniques, multidisciplinary approach, appropriate use of neoadjuvant therapy and perioperative care at centers of excellence in esophageal surgery. Esophagectomy is one of the most complicated and demanding procedures among all gastrointestinal surgeries with a very long learning curve in which excellence can only be achieved through improvement during all the surgical career. The results of esophagectomy are related not only to the volume of cases operated but also to the experience of surgeons in the management of postoperative complications. Initially, minimally invasive esophagectomy has encountered obstacles to implementation in several centers due to the cost and complexity of esophageal cancer treatment. Several meta-analyses and clinical trials published so far support the feasibility of the minimally invasive approach, the advantages of the post-operative period and the equivalence of oncological outcomes with the open technique, which is an important step in imposing minimally invasive techniques as a standard in the treatment of esophageal cancer. In this paper, we aim to analyze recent advances in minimally invasive esophagectomy, the evolution of endoscopic surgical techniques through our personal experience and the results of studies published in the medical literature in the last years.
由于手术技术的进步、多学科方法、新辅助治疗的合理应用以及在食管癌手术卓越中心的围手术期护理，食管癌的治疗变得更加有效。食管切除术是所有胃肠手术中最复杂、要求最高的手术之一，其学习曲线很长，只有在整个手术生涯中不断改进才能达到卓越水平。食管切除术的结果不仅与手术病例数量有关，还与外科医生处理术后并发症的经验有关。最初，由于食管癌治疗的成本和复杂性，微创食管切除术在几个中心的实施遇到了障碍。迄今为止发表的几项荟萃分析和临床试验支持了微创方法的可行性、术后优势以及与开放技术在肿瘤学结果上的等效性，这是将微创技术作为食管癌治疗标准的重要一步。在本文中，我们旨在分析微创食管切除术的最新进展、通过我们的个人经验看内镜手术技术的演变以及过去几年医学文献中发表的研究结果。
