Limitierte und minimal invasive Operationen beim ÖsophaguskarzinomLorenz D. · Origer J. · Graupe F.
Klinik für Allgemein- und Viszeralchirurgie, HSK Dr.-Horst-Schmidt-Kliniken GmbH, Wiesbaden, Deutschland
Limited and Minimally Invasive Operations in Esophageal Cancer Many centers favor a radical esophagectomy combined with systematic lymphadenectomy as standard operation also in early esophageal adenocarcinomas. Because of the substantial morbidity of this procedure the question arises if this surgical intervention is actually necessary in all patients with early carcinomas. The theoretical advantages of minimally invasive resection favor this technique in procedures with high morbidity, particularly as the use of this technique must not be limited to the treatment of early tumor stages. The first large case series are promising though there is a lack of reliable data because randomized controlled trials are still missing and the data from the case series are still controversial. Other strategies to limit the extent of surgical resection in early Barrett’s carcinoma are vagal-sparing esophagectomy and resection of the distal esophagus and esophagogastric junction with regional lymphadenectomy and jejunal interposition (modified Merendino’s technique). However, both procedures are not yet fully developed. In view of the success of endoscopic mucosal resection in esophageal carcinomas limited to the mucosa, we think that there will be no indication for vagal-sparing esophagectomy in the future. In our patients limited resection (Merendino’s technique; n = 29) showed to be advantageous when compared with conventional resection (n = 79) because of substantially lower morbidity and mortality. The patients with limited resection had a significantly shorter stay on the ICU and a shorter length of hospitalization, and the postoperative lost of weight was significantly less in this group as well. The oncologic long-term results in both groups were comparable.
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