Zusammenfassung
Die operative Therapie stellt bei den meisten Patienten mit Ösophaguskarzinom die einzige Möglichkeit auf potenzielle Heilung dar. Obwohl durch standardisierte Operationstechnik, Verbesserung der Anästhesietechniken und eine bessere Patientenselektion in den letzten Jahren eine deutliche Verminderung der perioperativen Mortalität und Morbidität in spezialisierten Zentren erreicht werden konnte, stellen Komplikationen häufig eine vitale Bedrohung des Patienten dar und haben wesentlichen Einfluss auf die Lebensqualität. Neben pulmonalen Komplikationen ist die Anastomoseninsuffizienz die wohl schwerwiegendste und deshalb am meisten gefürchtete Komplikation. In dieser Übersichtsarbeit sollen die gängigen Operationsverfahren insbesondere in Hinblick auf Anastomosentechniken und perioperative Komplikationen dargestellt werden.
Abstract
Surgical resection remains the standard of care and best chance for cure in the treatment of esophageal malignancy. Although surgical technique, patient selection and perioperative care have contributed to reduced perioperative mortality and morbidity in many specialized centers, pulmonary complications and anastomotic leakage still significantly influence the perioperative course and influence patient's quality of life. In this review we describe the different surgical procedures and anastomotic techniques and their influence on perioperative mortality and morbidity.
Schlüsselwörter
Ösophaguskarzinom - Morbidität - Anastomoseninsuffizienz
Key words
Esophageal carcinoma - morbidity - anastomotic leakage
Literatur
-
1
van Lanschot J J, Hulscher J B, Buskens C J. et al .
Hospital volume and hospital mortality for esophagectomy.
Cancer.
2001;
91
1574-1578
-
2
Brockmann J G, St. Nottberg H, Glodny B. et al .
CYFRA 21-1 serum analysis in patients with esophageal cancer.
Clin Cancer Res.
2000;
6
4249-4252
-
3
Hulscher J B, Tijssen J G, Obertop H, van Lanschot J J.
Transthoracic versus transhiatal resection for carcinoma of the esophagus: a metaanalysis.
Ann Thorac Surg.
2001;
72
306-313
-
4
Hsu H H, Chen J S, Huang P M. et al .
Comparison of manual and mechanical cervical esophagogastric anastomosis after esophageal resection for squamous cell carcinoma: a prospective randomized controlled trial.
Eur J Cardiothorac Surg.
2004;
25
1097-1101
-
5
Hölscher A H, Schröder W, Bollschweiler E. et al .
Wie sicher ist die hoch intrathorakale Ösophagogastrostomie?.
Chirurg.
2003;
74
726-733
-
6
Senninger N, Busse G, van Aken H.
Der respiratorische Problempatient.
Chirurg.
1997;
68
662-669
-
7
Law S, Wong K H, Kwok K F. et al .
Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer.
Ann Surg.
2004;
240
791-800
-
8
Meyer T, Merkel S, Gohl J. et al .
Veränderungen und Komplikationsrate in der Chirurgie des thorakalen Ösophaguskarzinoms.
Zentralbl Chir.
2003;
128
631-639
-
9
Chu K M, Law S Y, Fok M, Wong J.
A prospective randomized comparison of transhiatal and transthoracic resection for lower-third esophageal carcinoma.
Am J Surg.
1997;
174
320-324
-
10
Lerut T, Nafteux P, Moons J. et al .
Three-Field Lymphadenectomy for Carcinoma of the Esophagus and Gastroesophageal Junction in 174 R0 Resections: Impact on Staging, Disease-Free Survival, and Outcome: A Plea for Adaptation of TNM Classification in Upper-Half Esophageal Carcinoma.
Ann Surg.
2004;
240
962-974
-
11
Igaki H, Tachimori Y, Kato H.
Improved survival for patients with upper and/or middle mediastinal lymph node metastasis of squamous cell carcinoma of the lower thoracic esophagus treated with 3-field dissection.
Ann Surg.
2004;
239
483-490
-
12
Stein H J, Feith M, Müller J. et al .
Limited resection for early adenocarcinoma in Barrett's esophagus.
Ann Surg.
2000;
232
733-742
-
13
Hüttl T P, Wichmann M W, Geiger T K. et al .
Techniques and results of esophageal cancer surgery in Germany.
Langenbecks Arch Surg.
2002;
387
125-129
-
14
Gawad K A, Hosch S B, Bumann D. et al .
How important is the route of reconstruction after esophagectomy: a prospective randomized study.
Am J Gastroenterol.
1999;
94
1490-1496
-
15
Wong A C, Law S, Wong J.
Influence of the route of reconstruction on morbidity, mortality and local recurrence after esophagectomy for cancer.
Dig Surg.
2003;
20
209-214
-
16
van Lanschot J J, van Blankenstein M, Oei H Y, Tilanus H W.
Randomized comparison of prevertebral and retrosternal gastric tube reconstruction after resection of oesophageal carcinoma.
Br J Surg.
1999;
86
102-108
-
17
Orringer M B, Marshall B, Iannettoni M D.
Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis.
J Thorac Cardiovasc Surg.
2000;
119
277-288
-
18
Griffin S M, Lamb P J, Dresner S M. et al .
Diagnosis and management of a mediastinal leak following radical oesophagectomy.
Br J Surg.
2001;
88
1346-1351
-
19
Tübergen D, Diederich S, Ochmann S. et al .
Successful treatment of an aorto-gastric-bronchial fistula after esophagectomy by placement of double stents.
Gastrointest Endosc.
2002;
56
587-589
-
20
Katariya K, Harvey J C, Pina E, Beattie E J.
Complications of transhiatal esophagectomy.
J Surg Oncol.
1994;
57
157-163
-
21
Siewert J R, Stein H J, Bartels H.
[Anastomotic leaks in the upper gastrointestinal tract.].
Chirurg.
2004;
129
1063-1070
-
22
Casson A G, Porter G A, Veugelers P J.
Evolution and critical appraisal of anastomotic technique following resection of esophageal adenocarcinoma.
Dis Esophagus.
2002;
15
296-302
-
23
Law S, Fok M, Chu K M, Wong J.
Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer: a prospective randomized controlled trial.
Ann Surg.
1997;
226
169-173
-
24
Kelley S T, Coppola D, Karl R C.
Neoadjuvant chemoradiotherapy is not associated with a higher complication rate vs. surgery alone in patients undergoing esophagectomy.
J Gastrointest Surg.
2004;
8
227-231
-
25
Colombo-Benkmann M, Bossler S, Senninger N.
Prognostic factors of squamous cell carcinoma of the esophagus depend on the status after resection.
J Cancer Res Clin Oncol.
2004;
130 (Suppl 1)
78
-
26
Sauvanet A, Baltar J, Le Mee J, Belghiti J.
Diagnosis and conservative management of intrathoracic leakage after oesophagectomy.
Br J Surg.
1998;
85
1446-1449
-
27
Visbal A L, Allen M S, Miller D L, Deschamps C, Trastek V F, Pairolero P C.
Ivor Lewis esophagogastrectomy for esophageal cancer.
Ann Thorac Surg.
2001;
71
1803-1808
-
28
Konopke R, Kersting S, Ockert D, Gastmeier J, Säger H D.
Early results of esophageal surgery in carcinoma.
Swiss Surg.
2003;
9
173-180
-
29
Beitler A L, Urschel J D.
Comparison of stapled and hand-sewn esophagogastric anastomoses.
Am J Surg.
1998;
175
337-340
-
30
Laterza E, de' Manzoni G, Veraldi G F, Guglielmi A, Tedesco P, Cordiano C.
Manual compared with mechanical cervical oesophagogastric anastomosis: a randomised trial.
Eur J Surg.
1999;
165
1051-1054
Prof. Dr. med. N. Senninger
Klinik und Poliklinik für Allgemeine Chirurgie, Universitätsklinikum Münster
Waldeyerstr. 1
48149 Münster
Telefon: 02 51/8 35/63 04
Fax: 02 51/8 35/64 14
eMail: senning@uni-muenster.de