A nyelőcsőrák sebészi kezelésének változása az elmúlt 50 év folyamán

Abstract

Oesophageal surgery--apart from sporadic attempts--has a history of about fifty years. It was traditionally fallen into the realm of thoracic surgery developing collaterally and accomplished by the development of anaesthesiology and perioperative care. Initial surgery of the oesophagus begun by procedures aimed at tumours of the lower third and those of the gastroesophageal junction and the cardia. Surgical procedures for esophageal cancer became widespread by 1970's, leading to establishment of oesophageal surgical centres. Partial resections were succeeded by subtotal resections by 1980's. Hypopharyngeal and cervical oesophageal tumours were routinely extirpated in specialized centres by the 1990's. Extended lymph node dissection became routine and generally accepted. By the end of the decade, the importance of neoadjuvant radio-chemotherapy was highlighted and became inevitable. Growing experience of open transthoracic and blunt transhiatal resections without thoracotomy led to the onset of early thoracoscopic and laparoscopic procedures. The current practice for intraepithelial neoplasms is a minimally invasive procedure, such as endoscopic mucosectomy beside blunt transhiatal resection without thoracotomy. In case of submucosal tumours transthoracic or transhiatal blunt subtotal resections are recommended with 2-field lymphadenectomy. Solely subtotal resection with 2- or 3-field lymphadenectomy can be considered as curative intervention for advanced stage T2 cancer. In cases of T3 and T4 mid, or upper third and cervical neoplasms neoadjuvant radio-chemotherapy is recommended. Curative resection is only considered for responders.