Berlth Felix, Hadzijusufovic Edin, Mann Carolina, Fetzner Ulrich Klaus, Grimminger Peter
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Deutschland.
Klinik für Allgemeinchirurgie, Viszeral-, Thorax-, Kinder- und Endokrine Chirurgie, Johannes Wesling Klinikum, Universitätsklinikum der Ruhr Universität Bochum, Minden, Deutschland.
Ther Umsch. 2022 Apr;79(3-4):181-187. doi: 10.1024/0040-5930/a001346.
Minimally Invasive Esophagectomy for Esophageal Cancer Oncological esophagectomy with gastric pull up and intrathoracic represents the standard surgical procedure in the curative treatment of malignant tumors of the esophagus and the esophagogastric junction. The procedure, as two or three body cavities are accessed, has a natural level of invasiveness, which suggests lowering the surgical trauma using minimally invasive surgery (MIS). Because of the complexity of the surgical procedure, minimally invasive esophagectomy is an operation with relevant surgical learning curve. As of now, two principally different minimally invasive techniques for esophageal resection are established in clinical routine in specialized centers, the conventional laparoscopy/thoracoscopy based method and the robotic approach. Benefits of minimally invasive esophagectomy are reduced pulmonary complications and reduced postoperative pain. The surgical radicality of both minimally invasive techniques is at least comparable to the open approach and combined MIS/open approach, long-term survival outcomes from randomized controlled trials are pending. The robotic surgical technology has evolved dramatically over the last decade and oncological esophagectomy offers meaningful opportunity for application. Due to further technological progress, robotic surgery is expected to play an even more important role in the future. Focusing on the direct comparison of conventional minimally invasive esophagectomy and robotic-assisted esophagectomy, the randomized ROBOT-2 trial will reveal important evidence.
食管癌的微创食管切除术 采用胃上提和胸内吻合的肿瘤性食管切除术是食管癌和食管胃交界部恶性肿瘤根治性治疗的标准手术方法。由于该手术需进入两到三个体腔，其侵袭性自然较高，这提示可采用微创手术（MIS）降低手术创伤。由于手术操作复杂，微创食管切除术是一项具有相关手术学习曲线的手术。目前，在专业中心的临床常规中已确立了两种主要不同的微创食管切除技术，即基于传统腹腔镜/胸腔镜的方法和机器人手术方法。微创食管切除术的益处包括肺部并发症减少和术后疼痛减轻。两种微创技术的手术根治性至少与开放手术及微创/开放联合手术相当，随机对照试验的长期生存结果尚待确定。在过去十年中，机器人手术技术取得了巨大进展，肿瘤性食管切除术为其应用提供了有意义的机会。随着技术的进一步进步，机器人手术有望在未来发挥更重要的作用。聚焦于传统微创食管切除术与机器人辅助食管切除术的直接比较，随机对照的ROBOT-2试验将揭示重要证据。
