Surgery of esophageal cancer

TY - JOUR

T1 - Surgery of esophageal cancer

AU - Uzunoglu, F G

AU - Reeh, M

AU - Kutup, A

AU - Izbicki, J R

PY - 2013/2/1

Y1 - 2013/2/1

N2 - BACKGROUND: Surgery is the only option for curative treatment in patients with esophageal carcinoma. Despite the debates related to the peri-operative therapy regime, a generally accepted consensus on surgical approach is not reached yet. The debate focuses mainly on pros and cons between radical transthoracic resection and the (limited) transhiatal resection in the last decade.METHODS: The PubMed database was searched for randomized trials, meta-analyses, and retrospective single-center studies. The search terms were "esophageal carcinoma," "esophageal junction carcinomas," "transhiatal," "transthoracic," "morbidity," "mortality," and "surgery."RESULTS: The radical transthoracic approach should be the standard of care for esophageal carcinoma since it does not go along with an increased risk of postoperative morbidity or mortality but reveals an improved survival. Patient-related co-morbidities are the most influencing factors for the postoperative outcome. For type II esophageal junction carcinoma, treatment options from transhiatal extended gastrectomy to esophagectomy with hemigastrectomy or esophagogastrectomy with colonic interposition are existing. In type III esophagogastric junction carcinomas, the transhiatal extended gastrectomy is the standard of care, and the minimally invasive approach should be performed in specialized centers.CONCLUSION: Based on current available study results, this expert review provides a decision support for the best surgical strategy depending on tumor localization and patients' characteristics.

AB - BACKGROUND: Surgery is the only option for curative treatment in patients with esophageal carcinoma. Despite the debates related to the peri-operative therapy regime, a generally accepted consensus on surgical approach is not reached yet. The debate focuses mainly on pros and cons between radical transthoracic resection and the (limited) transhiatal resection in the last decade.METHODS: The PubMed database was searched for randomized trials, meta-analyses, and retrospective single-center studies. The search terms were "esophageal carcinoma," "esophageal junction carcinomas," "transhiatal," "transthoracic," "morbidity," "mortality," and "surgery."RESULTS: The radical transthoracic approach should be the standard of care for esophageal carcinoma since it does not go along with an increased risk of postoperative morbidity or mortality but reveals an improved survival. Patient-related co-morbidities are the most influencing factors for the postoperative outcome. For type II esophageal junction carcinoma, treatment options from transhiatal extended gastrectomy to esophagectomy with hemigastrectomy or esophagogastrectomy with colonic interposition are existing. In type III esophagogastric junction carcinomas, the transhiatal extended gastrectomy is the standard of care, and the minimally invasive approach should be performed in specialized centers.CONCLUSION: Based on current available study results, this expert review provides a decision support for the best surgical strategy depending on tumor localization and patients' characteristics.

KW - Anastomosis, Surgical

KW - Esophageal Neoplasms

KW - Esophagectomy

KW - Esophagogastric Junction

KW - Humans

KW - Lymph Node Excision

KW - Lymphatic Metastasis

KW - Surgical Procedures, Minimally Invasive

U2 - 10.1007/s00423-013-1052-y

DO - 10.1007/s00423-013-1052-y

M3 - SCORING: Journal article

C2 - 23354360

VL - 398

SP - 189

EP - 193

JO - LANGENBECK ARCH SURG

JF - LANGENBECK ARCH SURG

SN - 1435-2443

IS - 2

ER -