Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Moscow Clinical Scientific Center, Moscow, Russia.
Ann N Y Acad Sci. 2018 Dec;1434(1):192-209. doi: 10.1111/nyas.13677. Epub 2018 May 15.
Over the last decades, the treatment of resectable esophageal cancer has evolved into a multidisciplinary process in which all players are essential for treatment to be successful. Medical oncologists and radiation oncologists have been increasingly involved since the implementation of neoadjuvant therapy, which has been shown to improve survival. Although esophagectomy is still considered the cornerstone of curative treatment for locally advanced esophageal cancer, it remains associated with considerable postoperative morbidity, despite promising results of minimally invasive techniques. In this light, both physical status and response to neoadjuvant therapy may be important factors for selecting patients who will benefit from surgery. Furthermore, it is important to optimize the entire perioperative trajectory: from the initial outpatient clinic visit to postoperative discharge. Enhanced recovery after surgery is increasingly recognized for esophagectomy and emphasizes perioperative aspects, such as nutrition, physiotherapy, and pain management. To date, several facets of esophageal cancer treatment remain topics of debate, such as the preferred neoadjuvant treatment, anastomotic technique, extent of lymphadenectomy, organization of postoperative care, and the role of surgery beyond locally advanced disease. Here, we describe the current and future perspectives in the surgical treatment of patients with esophageal cancer in the context of the available literature.
在过去的几十年中，可切除食管癌的治疗已经发展成为一个多学科的过程，所有参与者对于治疗的成功都是至关重要的。自从新辅助治疗实施以来，医学肿瘤学家和放射肿瘤学家的参与度越来越高，因为新辅助治疗已经被证明可以提高生存率。尽管食管切除术仍然被认为是局部晚期食管癌的根治性治疗的基石，但即使微创手术的结果令人鼓舞，它仍然与相当大的术后发病率相关。有鉴于此，身体状况和对新辅助治疗的反应可能是选择将从手术中获益的患者的重要因素。此外，优化整个围手术期的轨迹也很重要：从最初的门诊就诊到术后出院。术后恢复加速计划在食管切除术中的应用越来越受到重视，强调了围手术期的方面，如营养、物理治疗和疼痛管理。迄今为止，食管癌治疗的几个方面仍然是争议的话题，例如首选的新辅助治疗、吻合技术、淋巴结清扫范围、术后护理的组织以及手术在局部晚期疾病之外的作用。在这里，我们根据现有文献描述了在食管癌患者的外科治疗方面的当前和未来的观点。
