Evidenz in der minimal-invasiven onkologischen Chirurgie des Ösophagus

Evidence in minimally invasive oncological surgery of the esophagus

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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Corresponding author

Correspondence to PD. Dr. H. F. Fuchs.

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Interessenkonflikt

B. Babic, L.M. Schiffmann, W. Schröder, C.J. Bruns und H.F. Fuchs geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Die Autoren B. Babic und L.M. Schiffmann teilen sich die Erstautorenschaft.

Reaktion

C.T. Germer, Würzburg

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Babic, B., Schiffmann, L.M., Schröder, W. et al. Evidenz in der minimal-invasiven onkologischen Chirurgie des Ösophagus. Chirurg (2021). https://doi.org/10.1007/s00104-020-01337-x

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Schlüsselwörter

  • Ösophaguskarzinom
  • Operationstechniken
  • Minimal-invasive Ösophagektomie
  • Robotisch assistierte Ösophagektomie
  • Outcome

Keywords

  • Esophageal cancer
  • Surgical techniques
  • Minimally invasive esophagectomy
  • Robot assisted esophagectomy
  • Outcome