In patients with esophageal carcinoma surgical resection remains the standard of curative treatment. For locally advanced tumors (pT1sm–pT3) transthoracic esophagectomy with extended lym- phadenectomy is the standa...In patients with esophageal carcinoma surgical resection remains the standard of curative treatment. For locally advanced tumors (pT1sm–pT3) transthoracic esophagectomy with extended lym- phadenectomy is the standard surgical procedure since it o?ers a complete removal of the primary tumor and possible lymph node metastases. This surgical resection is appropriate for squamous cell but also adenocarcinoma of the esophagus because both histological entities demonstrate a lymphatic spread to the abdominal compartment and the upper mediastinum. In-hospital mortality rates are between 6% and 9%; anastomotic leakage and pulmonary complications mainly contribute to postoperative morbidity. In terms of 5-year survival the transthoracic procedure o?ers a better prognosis compared to the transhiatal resection. 五笔字型计算机汉字输入技术展开更多
Surgery for esophageal cancer is a demanding procedure associated with a high rate (30%– 40%) of post-operative complications. Therefore, for esophageal cancer surgery, not only must the surgeon be trained for preope...Surgery for esophageal cancer is a demanding procedure associated with a high rate (30%– 40%) of post-operative complications. Therefore, for esophageal cancer surgery, not only must the surgeon be trained for preoperative preparation, operative therapy, and post-operative management, but also the entire hospital setting including physicians of di?erent specialties and intensive care units. In the past few years publications have been particularly concerned with comparing the outcomes of high-volume centers and other hospitals in cases of various tumor operations. Due to more experience, increased frequency of cases and better training conditions in high-volume centers, esophagectomies have been shown to have better outcomes, especially hospital mortality, when performed there than in centers performing them with less frequency. This review of the current literature for esophageal cancer surgery shows a clear reduction of postoperative mortality with increasing case volume per year. Single papers have analysed the main reasons for this phenomenon and showed that postoperative complication rates are lower in high-volume- hospitals and their management of complications is more succesful. In conclusion, the analysis shows that only with the experience of more than 20 esophagectomies per year a signi?cant reduction of the mortality down to <5% can be achieved.展开更多
Endoscopy together with endoscopic ultrasonography (EUS) are the most important diagnos- tics for esophageal cancer and staging of the primary. The results have important clinical consequences concerning type of resec...Endoscopy together with endoscopic ultrasonography (EUS) are the most important diagnos- tics for esophageal cancer and staging of the primary. The results have important clinical consequences concerning type of resection or multimodal approach. Further re?nements of endoscopy will increase its signi?cance especially for early cancer. EUS has an accuracy of 80% for the primary compared to 60% for the N-staging. Therefore EUS represents the gold standard for T-staging but it is of little value for detection of lymph node metastasis.展开更多
Thoracoscopic esophagectomy is only established in some centers and a?ords a cervical anasto- mosis because intrathoracic anastomosis as a routine is technically too di?cult. Laparoscopic mobilisation of the stomach (...Thoracoscopic esophagectomy is only established in some centers and a?ords a cervical anasto- mosis because intrathoracic anastomosis as a routine is technically too di?cult. Laparoscopic mobilisation of the stomach (gastrolysis) is an important contribution for minimal invasive surgery of esophageal cancer. This procedure reduces the stress of the two cavity operation for the patient and allows the construction of a comparable gastric conduit like by open surgery. The technique of laparoscopic gastrolysis as prepa- ration for transthoracic en bloc esophagectomy is described in detail and preliminary results are brie?y mentioned.展开更多
FDG-PET is of clinical value especially for detection of distant metastases or recurrent esophageal cancer. For the staging of primary tumor or locoregional lymph node metastasis PET is cur- rently not suitable.
The incidence of the adenocarcinoma of the esophagus (AC) has been rising exponentially in the Western World within the last 30 years. The reasons for this increase are not yet understood. Massive and long lasting gas...The incidence of the adenocarcinoma of the esophagus (AC) has been rising exponentially in the Western World within the last 30 years. The reasons for this increase are not yet understood. Massive and long lasting gastroesophageal re?ux causes the Barrett’s esophagus which is considered to be a precancerosis. Therefore early diagnosis and appropriate treatment of gastroesophageal re?ux is essential for the prevention of this tumor. This makes heartburn the leading clinical symptom in the patient’s history. In patients with heartburn it is possible to early endoscopically diagnose a Barrett’s esophagus or adenocarcinoma of the esophagus. However only few patients with this increased risk receive an index-endoscopy. In clinical studies a high rate of early carcinomas could be found and could be treated with mucosectomie or ablation. The majority of patients with AC present with symptoms suggestive of progressed disease such as dysphagia or weight loss. The prognosis in patients in late disease stages are with a 5-year survival of only 30% far worse than in patients with early carcinoma (85%). However the early symptoms such as heartburn or regurgitation are unspeci?c and make an e?ective diagnostical strategy di?cult. To optimize screening it would be bene?cial to identify patients with high risk for the development of adenocarcinoma of the esophagus.展开更多
文摘In patients with esophageal carcinoma surgical resection remains the standard of curative treatment. For locally advanced tumors (pT1sm–pT3) transthoracic esophagectomy with extended lym- phadenectomy is the standard surgical procedure since it o?ers a complete removal of the primary tumor and possible lymph node metastases. This surgical resection is appropriate for squamous cell but also adenocarcinoma of the esophagus because both histological entities demonstrate a lymphatic spread to the abdominal compartment and the upper mediastinum. In-hospital mortality rates are between 6% and 9%; anastomotic leakage and pulmonary complications mainly contribute to postoperative morbidity. In terms of 5-year survival the transthoracic procedure o?ers a better prognosis compared to the transhiatal resection. 五笔字型计算机汉字输入技术
文摘Surgery for esophageal cancer is a demanding procedure associated with a high rate (30%– 40%) of post-operative complications. Therefore, for esophageal cancer surgery, not only must the surgeon be trained for preoperative preparation, operative therapy, and post-operative management, but also the entire hospital setting including physicians of di?erent specialties and intensive care units. In the past few years publications have been particularly concerned with comparing the outcomes of high-volume centers and other hospitals in cases of various tumor operations. Due to more experience, increased frequency of cases and better training conditions in high-volume centers, esophagectomies have been shown to have better outcomes, especially hospital mortality, when performed there than in centers performing them with less frequency. This review of the current literature for esophageal cancer surgery shows a clear reduction of postoperative mortality with increasing case volume per year. Single papers have analysed the main reasons for this phenomenon and showed that postoperative complication rates are lower in high-volume- hospitals and their management of complications is more succesful. In conclusion, the analysis shows that only with the experience of more than 20 esophagectomies per year a signi?cant reduction of the mortality down to <5% can be achieved.
文摘Endoscopy together with endoscopic ultrasonography (EUS) are the most important diagnos- tics for esophageal cancer and staging of the primary. The results have important clinical consequences concerning type of resection or multimodal approach. Further re?nements of endoscopy will increase its signi?cance especially for early cancer. EUS has an accuracy of 80% for the primary compared to 60% for the N-staging. Therefore EUS represents the gold standard for T-staging but it is of little value for detection of lymph node metastasis.
文摘Thoracoscopic esophagectomy is only established in some centers and a?ords a cervical anasto- mosis because intrathoracic anastomosis as a routine is technically too di?cult. Laparoscopic mobilisation of the stomach (gastrolysis) is an important contribution for minimal invasive surgery of esophageal cancer. This procedure reduces the stress of the two cavity operation for the patient and allows the construction of a comparable gastric conduit like by open surgery. The technique of laparoscopic gastrolysis as prepa- ration for transthoracic en bloc esophagectomy is described in detail and preliminary results are brie?y mentioned.
文摘FDG-PET is of clinical value especially for detection of distant metastases or recurrent esophageal cancer. For the staging of primary tumor or locoregional lymph node metastasis PET is cur- rently not suitable.
文摘The incidence of the adenocarcinoma of the esophagus (AC) has been rising exponentially in the Western World within the last 30 years. The reasons for this increase are not yet understood. Massive and long lasting gastroesophageal re?ux causes the Barrett’s esophagus which is considered to be a precancerosis. Therefore early diagnosis and appropriate treatment of gastroesophageal re?ux is essential for the prevention of this tumor. This makes heartburn the leading clinical symptom in the patient’s history. In patients with heartburn it is possible to early endoscopically diagnose a Barrett’s esophagus or adenocarcinoma of the esophagus. However only few patients with this increased risk receive an index-endoscopy. In clinical studies a high rate of early carcinomas could be found and could be treated with mucosectomie or ablation. The majority of patients with AC present with symptoms suggestive of progressed disease such as dysphagia or weight loss. The prognosis in patients in late disease stages are with a 5-year survival of only 30% far worse than in patients with early carcinoma (85%). However the early symptoms such as heartburn or regurgitation are unspeci?c and make an e?ective diagnostical strategy di?cult. To optimize screening it would be bene?cial to identify patients with high risk for the development of adenocarcinoma of the esophagus.
