Modern standards and limits of surgery of the esophagus Prof. Dr. Guido Schumacher
Dept of General- and Visceral Surgery Städtisches Klinikum Braunschweig Braunschweig
Germany
There has been substantial changes In the treatment of esophageal cancer in the last 15 years. Interdisciplinary treatment is mandatory and every single patient has to be discussed in the tumour board before onset of treatment. While patients with T1 and T2 cancers receive primary surgical resection, T3 and T4 cancers routinely receive neoadjuvant chemotherapy (Adenocarcinoma) or neoadjuvant radiochemotherapy (squamous cell cancers). A dose of 45 Gy should not be exceeded because of the increasing chance of anastomotic leakage.
The standard surgical procedure is the abdomino-thoracic esophagectomy with gastric pull-up and intrathoracic anastomosis (Ivor Lewis). A minimal invasive approach is increasingly used, which might be completely
minimally invasive (laparoscopy and thoracoscopy), or performed as a hybrid procedure (laparoscopy and thoracotomy, or laparotomy and
thoracoscopy). A two-field-lymphadenectomy is part of all techniques and should be as radical as possible. Minimally invasive procedures lead to faster recovery, fewer complications and equal radicality. However it is technically demanding and should be operated by experienced surgeons for this technique, preferably in certified centers. The number of
interventions per year has direct correlation to the perioperative
outcome. Letality ranges from 2% in centers with over 30 procedures to 20% in centers with only two esophagectomies per year.
Robotic surgery is also increasingly used and shows the same quality of surgery as regular minimally invasive procedures. The actual trend indicates a wider use of robotic surgery in the future.
Adenocarcinomas of the esophagogastric junction (AEG) are considered as esophageal cancer in case of type I according to Siewert and receive an esophagectomy, while Type II and II cancers are operated as extended gastrectomy.
The modern standards and trends of surgery and interdisciplinary treatment will be presented
