Minimally invasive surgery modalities in the treatment of esophagial cancers

Year 2012, Volume: 29 Issue: 4S, 251 - 256, 07.05.2013

Hasan Fehmi Batırel H.Volkan Kara

https://doi.org/10.5835/jecm.omu.29.s4.010

Abstract

Malignant tumours of esophagus have an increasing frequency in the population with a high mortality. Surgery is the most important choice of treatment modality in the first 3 stages of the disease. In the open surgery methods for esophagial cancers, mortality and morbidity rates are between 5-15% and 30-60% respectively. Due to these high rates for mortality and morbidity, minimally invasive surgery (MIS) gained great importance in the treatment of these patients. Patient selection in esophagial cancer treatment by using MIS is very important. These modalities can be used for lesions located in middle-distal portion of esophagus. Tumours should not have any invasion to adjacent structures, widespread lymph node invasions and should be staged between
T1-3 N0-1. Lateral decubitus and also prone position can be used for MIS. There are still no controlled randomised studies comparing MIS to open surgery for esophagial cancers. But retrospective series show that oncologic results are similar and postoperative complications are better in MIS groups. On the current daily practice MIS are done by experienced institutuions and surgical groups. In the future MIS will be used more commonly in treatment of esophagial cancers by improvement in invasive skills and infrastructures in the institutions

Keywords

Esophagial cancer, Minimally invasive surgery, Treatment

Özofagus kanserleri tedavisinde minimal invaziv cerrahi uygulamaları

Abstract

Özofagus kanserleri toplumda giderek daha sık görülen yüksek mortaliteyle seyreden bir hastalıktır. Cerrahi özofagus kanserlerinin ilk üç evresinde en önemli tedavi yöntemidir. Açık yapılan özofagus kanser mortalite ve morbidite oranları sırasıyla % 5-15 ve % 30- 60 arasında değişmektedir. Bu yüksek mortalite ve morbidite nedeniyle minimal invazif cerrahi (MİC) önem kazanmıştır. Özofagus kanseri için uygulanan MİC’de hasta seçimi çok önemlidir. Bu yöntemler orta-distal özofagusta yer alan, çevreye invazyonu veya yaygın lenf nodu metastazı bulunmayan evre T1-3 N0-1 tümörlerde uygulanabilir. MİC’de lateral dekübitus pozisyon kullanılabildiği gibi, yüz üstü pozisyonda kullanılmaktadır. MİC ile açık özofajektomi sonuçlarını kıyaslayan randomize kontrollü bir çalışma henüz yoktur, ancak mevcut retrospektif vaka serilerinden çıkan sonuçlara göre MİC’nin onkolojik sonuçlar açısından konvasiyonel özofajektomiye benzer, postoperatif komplikasyonlar açısından ise daha iyi sonuçlara sahip olduğu belirtilmektedir. Halihazırda özofagus kanserinde MİC ciddi deneyime sahip ekipler tarafından uygulanmaktadır. MİC girişim becerilerinin ve alt yapıların geliştirilmesi ile daha sık uygulanabilecektir

Keywords

Özofagus kanseri, Minimal invaziv cerrahi, Tedavi

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