Zusammenfassung
Hintergrund
Die thorakoabdominale Ösophagektomie spielt bei der Therapie des Ösophaguskarzinoms weiterhin die tragende Rolle. Minimal-invasive Verfahren wurden entwickelt, um die hohe Rate an postoperativer Morbidität und Mortalität zu reduzieren, ohne das onkologische Ergebnis dabei zu gefährden.
Fragestellung
Welche Evidenz besteht in der minimal-invasiven onkologischen Chirurgie des Ösophagus? Profitieren Patienten von einer minimal-invasiven Ösophagektomie im Vergleich zur offenen Technik? Ist eine Reduktion des chirurgischen Zugangstraumas im Einzelnen von Vorteil?
Material und Methodik
Die internationale Literatur wurde gesichtet, ausgewertet und kritisch analysiert.
Ergebnisse
Drei prospektiv randomisierte Studien bestätigen eine Reduktion der postoperativen Morbidität durch die Reduktion des chirurgischen Zugangstraumas bei mindestens gleichwertigem onkologischem Ergebnis. Zu diesem Ergebnis kommen auch diverse retrospektive Analysen sowie Metaanalysen.
Schlussfolgerung
Eine Minimierung des chirurgischen Zugangstraumas bei der thorakoabdominalen Ösophagektomie führt zu einer Reduktion der postoperativen Morbidität im Vergleich zur offenen Chirurgie. Das onkologische Ergebnis bleibt davon nach aktueller Datenlage unbeeinträchtigt.
Abstract
Background
Thoracoabdominal esophagectomy still plays a major role in the oncological treatment for esophageal cancer. Minimally invasive procedures were developed to reduce the high rate of postoperative morbidity and mortality without negatively affecting the oncological outcome.
Objective
What evidence supports minimally invasive oncological surgery of the esophagus? Do patients benefit from minimally invasive esophagectomy compared to an open approach? Is the reduction of surgical access trauma specifically advantageous?
Material and methods
Review, evaluation and critical analysis of the international literature.
Results
A reduction in postoperative morbidity by decreasing surgical trauma was confirmed by three prospective randomized clinical trials, while showing at least similar oncological outcomes. Diverse retrospective analyses and meta-analyses also came to the same result.
Conclusion
A minimization of surgical access trauma during thoracoabdominal esophagectomy reduces postoperative morbidity compared to conventional open surgery. Recent evidence suggests that oncological outcomes are not altered depending on the surgical approach.
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B. Babic, L.M. Schiffmann, W. Schröder, C.J. Bruns und H.F. Fuchs geben an, dass kein Interessenkonflikt besteht.
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C.T. Germer, Würzburg
Die Autoren B. Babic und L.M. Schiffmann teilen sich die Erstautorenschaft.
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Babic, B., Schiffmann, L.M., Schröder, W. et al. Evidenz in der minimal-invasiven onkologischen Chirurgie des Ösophagus. Chirurg 92, 299–303 (2021). https://doi.org/10.1007/s00104-020-01337-x
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DOI: https://doi.org/10.1007/s00104-020-01337-x
Schlüsselwörter
- Ösophaguskarzinom
- Operationstechniken
- Minimal-invasive Ösophagektomie
- Robotisch assistierte Ösophagektomie
- Outcome