食管癌外科治疗的进展与未来

Progress and future of esophageal cancer surgery

  • 摘要: 食管癌外科治疗正迈向微创化与个体化。胸腹腔镜联合手术因其更优的短期疗效和潜在的生存获益已成为主流。机器人手术系统在精准淋巴结清扫,尤其是喉返神经保护方面展现优势。经颈纵隔镜手术为不耐受经胸手术的患者提供了新选择。对于食管胃结合部癌,经胸与经腹入路的选择应基于食管侵犯长度等因素个体化决策。颈段食管癌的治疗中,喉功能保留手术的地位日益凸显。此外,新辅助治疗后的主动监测(保器官策略)以及转化和(或)挽救性手术,为特定患者提供了更多治愈机会。笔者总结食管癌外科治疗的最新进展,并对未来发展方向进行展望,以期为临床实践提供参考。

     

    Abstract: The surgical treatment of esophageal cancer is moving towards minimally invasiveness and individualization. Thoracoscopic‑laparoscopic esophagectomy has become the mainstream due to its superior short‑term outcomes and potential survival benefits. Robotic surgery demonstrates advantages in precise lymph node dissection, particularly in the protection of the recurrent laryngeal nerve. Transcervical mediastinoscopic esophagectomy provides a new option for patients unable to tolerate transthoracic surgery.For adenocarcinoma of esophagogastric junction, the choice between transthoracic and transabdominal approaches should be individualized based on factors such as the extent of esophageal invasion. In the treatment of cervical esophageal cancer, larynx‑preserving surgery is increasingly prominent. Additionally, active surveillance (organ-preser-vation strategy) after neoadjuvant therapy, as well as conversion and salvage surgeries, offer more curative opportunities for specific patients. The authors review the latest advances in the surgical treatment of esophageal cancer, provide an outlook on future directions, with the aim of offering references for clinical practice.

     

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