Minimally Invasive Esophagectomy
Radical surgery currently offers the most realistic chance of cure for cancer of the esophagus or gastroesophageal junction (GEJ) when spread beyond the most superficial epithelial layers, but not extending beyond locoregional lymph nodes [1, 2]. Nowadays
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Philippe Nafteux, Georges Decker, and Toni E.M.R. Lerut
Contents 34.1
Introduction ................................................ 339
34.2
Preoperative Evaluation ............................ 340
34.3 34.3.1
Techniques .................................................. 340 Laparoscopic and Thoracoscopic Esophagectomy ............................................ 341
34.4 34.4.1
Other Operative Techniques ..................... Thoracoscopic Esophageal Resection in Prone Decubitus Position......................... Laparoscopic Transhiatal Esophagectomy ............................................ Minimally Invasive Ivor-Lewis Esophagectomy ............................................
34.4.2 34.4.3
347
352 352 355 356
34.8
Conclusion .................................................. 356
References ................................................................. 357
34.1
Introduction
349 350
Post-operative Management ..................... 350
34.6 34.6.1
Complications ............................................. Atelectasis and Respiratory Complications .............................................. Anastomotic Leak ........................................ Anastomotic Stricture .................................. Delayed Gastric Emptying ........................... Reflux ...........................................................
P. Nafteux, M.D. () • G. Decker, M.D. T.E.M.R. Lerut, M.D., Ph.D. Department of Thoracic Surgery, UZ Gasthuisberg, Herestraat 49, Leuven 3000, Belgium e-mail: [email protected]; [email protected]; [email protected]
Results ......................................................... Post-operative Characteristics ...................... Oncologic Results ........................................ Quality of Life..............................................
347
34.5
34.6.2 34.6.3 34.6.4 34.6.5
34.7 34.7.1 34.7.2 34.7.3
351 351 351 351 351 352
Radical surgery currently offers the most realistic chance of cure for cancer of the esophagus or gastroesophageal junction (GEJ) when spread beyond the most superficial epithelial layers, but not extending beyond locoregional lymph nodes [1, 2]. Nowadays experienced centers can consistently perform such an aggressive “conventional” surgery with mortality rates of 3–5% and consistently obtain overall 5-year survival rates of at least 35–40% [1–3]. Few other oncological operations however are as heavily influenced by experience than esophagectomy for cancer, and experienced centers not only achieve lower mortality rates but also much higher cure rates than low-volume centers [4, 5]. However, despite considerable improvements in outcome due to better cancer staging, patient selection, and surgical techniques during the last decade, overall and pulmonary complication rates have remain sufficiently high to encourage the search for alternative operative techniques that could potentially achieve similar cure rates but with less morbidity and probably a better postoperative quality of life.
R.G.C. In
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