Skip to main content
SpringerLink
Log in

En-bloc Resektion der Speiseröhre beim Oesophaguscarcinom

En-bloc esophagectomy in esophageal cancer

  • Aktuelle Operationstechniken
  • Published:
Langenbecks Archiv für Chirurgie Aims and scope Submit manuscript

Summary

En-bloc esophagectomy not only comprises the elimination of the esophagus but also the mediastinal lymphadenectomy and the resection of the azygos vein and thoracic duct. Additionally the suprapancreatic abdominal lymphadenectomy is included and in tumors located orally of the tracheal bifurcation also the cervical lymphadenectomy. The surgical technique can be estimated as fully developed and standardized. Possible complications are postoperative hemorrhage (3.3%), chylothorax (1.6%) and tracheal lesions (4.9%). The mortality rate ranges under 10% in experienced centers, in our own patients around 6.6%. With en-bloc esophagectomy an exact staging of esophageal cancer becomes possible. In a high percentage complete tumor elimination (R0-resection) can be achieved and it seems that herewith prognosis in early tumor stages (T1/2 N0/1) can be improved.

Zusammenfassung

Die en-bloc Oesophagektomie erfaßt neben der Entfernung der Speiseröhre die mediastinale Lymphadenektomie incl. der Resektion von V. azygos und Ductus thoracicus. Zusätzlich beinhaltet sie die suprapankreatische abdominelle Lymphadenektomie und bei oberhalb der Trachealbifurkation gelegenen Tumoren auch die cervicale Lymphadenektomie. Die Operationstechnik kann als ausgereift und standardisiert angesehen werden. Mögliche Komplikationen sind Nachblutungen (3,3%), Chylothorax (1,6%) und Trachealäsionen (4,9%). Die Letalität liegt in erfahrenen Zentren unter 10%, im eigenen Krankengut bei 6,6%. Die en-bloc Oesophagektomie ermöglicht ein exaktes Staging des Oesophaguscarcinoms, führt in einem hohen Prozentsatz zur kompletten Tumorentfernung (R0-Resektion) und scheint die Prognose früher Tumorstadien (T1/2 N0/1) zu verbessern.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Literatur

  1. Adolf J, Bartels H, Siewert JR (1988) Transthoracic esophagectomy combined with regional lymphadenectomy and reconstruction with delayed urgency versus transmediastinal esophagectomy and immediate reconstruction: Effect on cardiopulmonary function. In: Siewert JR, Hölscher AH (Hrsg) Diseases of the esophagus. Springer, Berlin Heidelberg New York, S 232–236

    Google Scholar 

  2. Akiyama H (1980) Surgery for carcinoma of the esophagus. Curr Probl Surg XVII (2):55–120

    Google Scholar 

  3. Akiyam H, Tsurumaru M, Kawamura T (1981) Principles of surgical treatment for carcinoma of the esophagus. Analysis of lymph node involvement. Ann Surg 194:438–445

    Google Scholar 

  4. Barbier PA, Becker CD, Wagner HE (1988) Esophageal carcinoma: Patient selection for transhiatal esophagectomy. A prospective analysis of 50 consecutive cases. World J Surg 12:263–269

    Google Scholar 

  5. Barbier PA, Luder PJ, Schüpfer G, Becker CD, Wagner HE (1988) Quality of life and patterns of recurrence following transhiatal esophagectomy for cancer: Results of a prospective follow-up in 50 patients. World J Surg 12:270–276

    Google Scholar 

  6. Giuli R, Sancho-Garnier H (1986) Diagnostic, therapeutic, and prognostic features of cancers of the esophagus: Results of the international prospective study conducted by the OESO group (790 patients). Surgery 99:614–622

    Google Scholar 

  7. Inokuchi K (1988) Milestones in the treatment of esophageal cancer along the road to improved results. Dis Esoph 1:13–18

    Google Scholar 

  8. Ishida K, Mori S, Okamoto K, Ohtsu T, Murakami K, Suzuki K, Satho N (1988) Results of extended dissection of lymph nodes in operation for thoracic esophageal cancer. In: Siewert JR, Hölscher AH (Hrsg) Diseases of the esophagus. Springer, Berlin Heidelberg New York, S 694–696

    Google Scholar 

  9. Japanese Committee of Registration of Esophageal Cancer (1985) A proposal for a new TNM classification of esophageal carcinoma. Jpn J Clin Oncol 14:625–636

    Google Scholar 

  10. Kakegawa T, Yamada H, Fujita H, Machi J (1986) Radical operation of thoracic esophageal carcinoma. In: Kasai M (Hrsg) Esophageal cancer. Excerpta Medica, Amsterdam, S 122–125

    Google Scholar 

  11. Kodama M, Shibata J, Shiogai Y, Yamagishi H, Oka T (1988) Analysis of surgical treatment of esophageal cancer with the aim of obtaining better results. In: Siewert JR, Hölscher AH (Hrsg) Diseases of the esophagus. Springer, Berlin Heidelberg New York, S 700–702

    Google Scholar 

  12. Lehr L, Rupp N, Siewert JR (1988) Assessment of resectability of esophageal cancer by computed tomography and magnetic resonance imaging. Surgery 103:344–350

    Google Scholar 

  13. Logan A (1963) The surgical treatment of carcinoma of the esophagus and cardia. J Thorac Cardiovasc Surg 46:150–161

    Google Scholar 

  14. Mori S, Ishida K (1988) Results of the extensive lymphadenectomy for thoracic esophageal carcinoma. 10th World Congress CICD, Copenhagen

  15. Nishihira T, Watanabe T, Ohmori N, Kitamura M, Toyoda T, Hirayama K, Kawachi S, Kuramoto J, Kanoh T, Akaishi T, Sekine Y, Kasai M (1984) Long-term evaluation of patients treated by radical operation for carcinoma of the thoracic esophagus. World J Surg 8:778–785

    Google Scholar 

  16. Peracchia A, Bardini R, Ruol A, Asolati M, Segalin A, Cavazzini F, Castoro C (1988) Blunt esophagectomy without thoracotomy for carcinoma of the esophagus: Experience in 127 patients. In: Siewert JR, Hölscher AH (Hrsg) Diseases of the esophagus. Springer, Berlin Heidelberg New York, S 394–397

    Google Scholar 

  17. Sasaki K, Muto T, Tanaka O, Soga J (1988) The significance of systemic lymphadenectomy for thoracic esophageal carcinoma. In: Siewert JR, Hölscher AH (Hrsg) Diseases of the esophagus. Springer, Berlin Heidelberg New York, S 697–702

    Google Scholar 

  18. Sasaki K, Muto T, Tanaka O, Soga J (1988) The significance of systematic lymphadenectomy for thoracic esophageal carcinoma. 10th World Congress CICD, Copenhagen

  19. Siewert JR (1988) Esophageal cancer from the European point of view. Jpn J Surg (im Druck)

  20. Siewert JR (1988) Leistungen der Tumorchirurgie bei Tumoren der Speiseröhre. Langenbecks Arch Chir (Kongreßber) Suppl II:119–126

    Google Scholar 

  21. Siewert JR (Hrsg) (1988) Breitner'sche Operationslehre —Abdominalchirurgie, Bd VI (im Druck)

  22. Siewert JR, Hölscher AH (Hrsg) (1988) Diseases of the esophagus. Springer, Berlin Heidelberg New York

    Google Scholar 

  23. Siewert JR, Hölscher AH, Adolf J, Bartels H, Hölscher M, Weiser HF (1988) Esophageal cancer: En-bloc esophagectomy with mediastinal lymphadenectomy and esophageal reconstruction with delayed urgency. In: Siewert JR, Hölscher AH (Hrsg) Diseases of the esophagus. Springer, Berlin Heidelberg New York, S 427–432

    Google Scholar 

  24. Siewert JR, Hölscher AH, Horváth ÖP (1986) Transmediastinale Oesophagektomie. Langenbecks Arch Chir 367:203–213

    Google Scholar 

  25. Siewert JR, Lange J, Böttcher K, Becker K, Stier A (1986) Lymphadenektomie beim Magencarcinom. Langenbecks Arch Chir 348:137–148

    Google Scholar 

  26. Siewert JR, Roder JD (1987) Chirurgische Therapie des Plattenepithelcarcinoms des Oesophagus — erweiterte Radikalität. Langenbecks Arch Chir (Kongreßber) 372:129–139

    Google Scholar 

  27. Skinner DB (1983) En bloc resection for neoplasms of the esophagus and cardia. J Thorac Cardiovasc Surg 85:59–71

    Google Scholar 

  28. Skinner DB, Soriano A, Little AG, Ferguson MK (1988) Selection of patients for en bloc esophagectomy. In: Siewert JR, Hölscher AH (Hrsg) Diseases of the esophagus. Springer, Berlin Heidelberg New York, S 411–415

    Google Scholar 

  29. Watanabe H (1987) Surgical treatment of thoracic esophageal cancer. 38° Congresso Uruguayo de Cirugia, Montevideo, Dec 7–11, Uruguay

  30. Yoshida M, Iwatsuka M (1988) Extended lymph node dissection for thoracic esophageal cancer. In: Siewert JR, Hölscher AH (Hrsg) Diseases of the esophagus. Springer, Berlin Heidelberg New York, S 421–426

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik, Technische Universität München, Klinikum rechts der Isar, Ismaninger Straße 22, D-8000, München 80

    J. R. Siewert, A. H. Hölscher, J. Roder & H. Bartels

Authors
  1. J. R. Siewert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. H. Hölscher
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Roder
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Bartels
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Siewert, J.R., Hölscher, A.H., Roder, J. et al. En-bloc Resektion der Speiseröhre beim Oesophaguscarcinom. Langenbecks Arch Chiv 373, 367–376 (1988). https://doi.org/10.1007/BF01272555

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01272555

Key words

Search

Navigation