Minimally Invasive Esophageal Resection
| Autor: | Wim T. van den Broek, Sijbren Meijer, Miguel A. Cuesta, Donald L. van der Peet |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Microsurgery
medicine.medical_specialty Esophageal Neoplasms medicine.medical_treatment Esophageal Diseases Postoperative Complications Laparotomy medicine Thoracoscopy Humans Minimally Invasive Surgical Procedures Thoracotomy Esophagus Laparoscopy Lung medicine.diagnostic_test business.industry Respiratory infection Esophageal cancer medicine.disease Surgery Esophagectomy medicine.anatomical_structure Esophagoscopy business |
| Zdroj: | Surgical Innovation. 11:147-160 |
| ISSN: | 1553-3506 |
| Popis: | Esophagus resection is the adequate treatment for some benign esophageal diseases, especially caustic and peptic stenosis and end-stage motility dysfunction. However, the most frequent indications for esophageal resection are the high-grade dysplasia of Barrett esophagus and nonmetastasized esophageal cancer. Different procedures have been developed to perform esophageal resection given the 5-year survival rate among operated patients of only 18%. The disadvantage of the conventional approach is the high morbidity rate, especially with pulmonary complications. Minimally invasive esophageal resections, which were first performed in 1991, may reduce this important morbidity and preserve the oncologic outcome. The first reports of morbidity and respiratory complications with this approach were discouraging and it seemed likely that the procedure would have to be abandoned. However, in the last 5 years, an important impetus for these techniques was given by Japanese groups and the group of Luketich in Pittsburgh. The outcomes of these new series are different than those of the beginning period, leading to an enormous expansion worldwide. Important factors for this change are the standardization of the operative technique, the experience of many surgeons with more advanced laparoscopic procedures, important improvements in instruments for dissection and division of tissues, a better anesthesia technique, and a better selection of patients for operation. Two minimally invasive techniques are being perfected: the three-stage operation by right thoracoscopy and laparoscopy, and the transhiatal laparoscopic approach. It seems that the first approach may be applied successfully for any tumor in the esophagus, whereas the transhiatal seems ideal for distal esophageal and esophagogastric junction tumors. This review paper discusses all these aspects, with special attention for indications and operative technique. |
| Databáze: | OpenAIRE |
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