Surgical treatment of esophageal cancer has been a hundred years of history. Geray first reported in 1877, the success of cervical esophageal resection. Many later scholars have conducted in-depth study and methods, so that surgical resection rate and survival rate increased. Professor Wu Yingai of the first line in 1940, esophageal resection of intrathoracic anastomosis to be successful. Current surgical treatment of esophageal cancer has been launched in the country generally, and accumulated a lot of experience, with the depth of esophageal cancer basic research and new technologies, the emergence of new methods, treatment of esophageal cancer is also rising.
1.1 Operative indications Surgical treatment of esophageal cancer
early esophageal cancer, once diagnosed, surgical treatment should be positive.
II of the previous cases, no serious complications.
III of the cases, preoperative radiotherapy may be considered a comprehensive treatment, although the lower esophageal cancer surgery may also be considered 7cm long.
recurrence after radiotherapy, lesions small, distant metastasis, conditions permitting, should also be taken to surgery.
highly esophageal obstruction, the patient generally, and can be considered retrosternal esophageal replacement with colon after the use of radiotherapy given to
1.2 Contraindications
X ray imaging or CT of esophageal lock meal examination who invades adjacent vital organs.
have distant metastasis
with severe cardiopulmonary dysfunction
There cachexia appears.
1.3 Factors affecting the surgical resection
The success of esophageal cancer treatment, the decision whether the lesions spread to organizations outside the esophagus, the lesion resection rate of the length of some reference to judge the significance of upper esophageal carcinoma in more than 6cm, 7cm above the lower esophageal resection rate is not high . Clinical staging and resection rate is closely related to 0 and I on the resection rate was 100%, II stage resection rate was 95%, III 80% of the production cut, concave on the removal rate of about 50%. Generally lower removal of high, middle and upper lower resection, preoperative radiotherapy can make esophageal adhesions around the tumor becomes malignant fibrous adhesion, thereby enhancing the rate of surgical resection.
1.4 The choice of surgical treatment of esophageal cancer surgical treatment of esophageal carcinoma using esophageal subtotal excision and most of esophagogastric anastomosis, the left chest or right chest posterolateral incision, the stomach, large and small bending free, the pull to the chest, in the aortic arch on the upper mediastinum to do the esophagus, stomach anastomosis, gastric pull when necessary, can also be made to the neck, esophagus, stomach anastomosis. Resection of esophageal cancer nearly 20 years has been much progress, not a surgical indication on esophageal cancer, but can only do the views of radiotherapy has been broken, but the upper esophageal surgeries, should be strictly the indications.
Esophageal reconstruction with a stomach transplant surgery is simple, low incidence of anastomotic thin, but the impact of postoperative gastric dilatation occupying the chest cardiopulmonary function. With the colon, small intestine instead of esophageal reconstruction is widely used in clinical, as the function of the stomach retained to avoid postoperative reflux esophagitis, but the more complicated surgical operation, anastomotic, and easy to place fistula.
Surgical treatment of esophageal cancer, esophageal cancer resection length, generally from the tumor, 5cm above the lower edge, including connective tissue and lymph nodes around the esophagus should be clean. Subcarinal lymph nodes of esophageal cancer are often middle and upper mediastinal lymph nodes are commonly responsible for the lower door of esophageal or gastric artery lymph node metastasis.