Schröder Wolfgang, Gisbertz Suzanne S, Voeten Daan M, Gutschow Christian A, Fuchs Hans F, van Berge Henegouwen Mark I
Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany.
Cancer Center Amsterdam, Department of Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
Cancers (Basel). 2021 Nov 21;13(22):5834. doi: 10.3390/cancers13225834.
Transthoracic esophagectomy is currently the predominant curative treatment option for resectable esophageal adenocarcinoma. The majority of carcinomas present as locally advanced tumors requiring multimodal strategies with either neoadjuvant chemoradiotherapy or perioperative chemotherapy alone. Minimally invasive, including robotic, techniques are increasingly applied with a broad spectrum of technical variations existing for the oncological resection as well as gastric reconstruction. At the present, intrathoracic esophagogastrostomy is the preferred technique of reconstruction (Ivor Lewis esophagectomy). With standardized surgical procedures, a complete resection of the primary tumor can be achieved in almost 95% of patients. Even in expert centers, postoperative morbidity remains high, with an overall complication rate of 50-60%, whereas 30- and 90-day mortality are reported to be <2% and <6%, respectively. Due to the complexity of transthoracic esophagetomy and its associated morbidity, esophageal surgery is recommended to be performed in specialized centers with an appropriate caseload yet to be defined. In order to reduce postoperative morbidity, the selection of patients, preoperative rehabilitation and postoperative fast-track concepts are feasible strategies of perioperative management. Future directives aim to further centralize esophageal services, to individualize surgical treatment for high-risk patients and to implement intraoperative imaging modalities modifying the oncological extent of resection and facilitating surgical reconstruction.
经胸段食管癌切除术目前是可切除食管腺癌的主要根治性治疗选择。大多数癌表现为局部晚期肿瘤，需要采用新辅助放化疗或单纯围手术期化疗的多模式策略。包括机器人手术在内的微创技术应用越来越广泛，肿瘤切除及胃重建存在广泛的技术差异。目前，胸内食管胃吻合术是首选的重建技术（艾弗·刘易斯食管癌切除术）。通过标准化手术操作，几乎95%的患者可实现原发肿瘤的完全切除。即使在专家中心，术后发病率仍然很高，总体并发症发生率为50%-60%，而据报道30天和90天死亡率分别<2%和<6%。由于经胸段食管癌切除术的复杂性及其相关发病率，建议在病例数量合适（但尚未明确）的专业中心进行食管手术。为降低术后发病率，患者选择、术前康复和术后快速康复理念是围手术期管理的可行策略。未来的指导方针旨在进一步集中食管治疗服务，为高危患者个体化手术治疗，并采用术中成像模式来改变肿瘤切除范围并促进手术重建。
