Kikuchi Hirotoshi, Takeuchi Hiroya
Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
Ann Thorac Cardiovasc Surg. 2018 Oct 19;24(5):219-222. doi: 10.5761/atcs.ed.18-00126. Epub 2018 Jun 29.
Esophageal cancer is one of the leading causes of cancer-related death worldwide. Surgery plays an important role in the treatment strategies for esophageal cancer. Recent advances in surgical techniques and perioperative management have dramatically improved the mortality rate; however, esophagectomy remains a highly invasive procedure that can lead to severe postoperative complications. Future advances in thoracoscopic surgery with the development of surgical endoscopy systems such as three-dimensional (3D) imaging systems with a 4K ultra high-definition camera or two-dimensional (2D) imaging systems with an 8K camera, which is expected to provide 3D-like visual sensation, will enable us to further understand the microscopic anatomy of the thoracic cavity and mediastinum, and to perform delicate surgical procedures that enable minimally invasive esophagectomy with mediastinal lymphadenectomy. A robot-assisted thoracoscopic esophagectomy is attractive for surgeons and may be beneficial to esophageal cancer patients. Preoperative simulation and intraoperative real-time navigation are expected to further help surgeons safely perform esophagectomy with lymphadenectomy. Reduction of the lymphadenectomy field and setting of lymphadenectomy areas with highest priority may be feasible when sentinel node (SN) navigation is appropriately performed in cN0 early-stage esophageal cancer. These technical advances are expected to decrease the morbidity and mortality rate of surgery for esophageal cancer and hopefully improve oncological outcomes.
食管癌是全球癌症相关死亡的主要原因之一。手术在食管癌的治疗策略中起着重要作用。手术技术和围手术期管理的最新进展显著提高了死亡率；然而，食管切除术仍然是一种高侵入性手术，可导致严重的术后并发症。随着手术内镜系统的发展，如配备4K超高清摄像头的三维（3D）成像系统或配备有望提供类似3D视觉感受的8K摄像头的二维（2D）成像系统，胸腔镜手术的未来进展将使我们能够进一步了解胸腔和纵隔的微观解剖结构，并进行精细的手术操作，实现微创食管切除术并同时进行纵隔淋巴结清扫。机器人辅助胸腔镜食管切除术对外科医生具有吸引力，可能对食管癌患者有益。术前模拟和术中实时导航有望进一步帮助外科医生安全地进行食管切除术并清扫淋巴结。在cN0早期食管癌中适当进行前哨淋巴结（SN）导航时，缩小淋巴结清扫范围并确定优先级最高的淋巴结清扫区域可能是可行的。这些技术进步有望降低食管癌手术的发病率和死亡率，并有望改善肿瘤学结局。
