Minimalinvasive Chirurgie des Ösophaguskarzinoms – Eine onkologisch sichere Methode mit signifikanten Vorteilen zur offenen Technik

Zusammenfassung

Die Inzidenz des Ösophaguskarzinoms hat sich in den letzten 30 Jahren versiebenfacht und zählt somit zu der am schnellsten zunehmenden Tumorentität der westlichen Welt. Die Therapie des Ösophaguskarzinoms ist in ein multimodales Konzept eingebettet und beinhaltet neben der chirurgischen Resektion sowie endoskopischen Verfahren die Strahlen- und Chemotherapie. Die offene Ösophagusresektion ist mit einer hohen postoperativen Morbidität vergesellschaftet. Daher haben sich in den letzten Jahren zunehmend die minimalinvasiven Techniken sowie die roboter-assistierte Chirurgie etabliert. Studien konnten einen signifikanten Vorteil der minimalinvasiven Resektion aufzeigen: Die postoperativen Schmerzen waren geringer, die Rekonvaleszenz kürzer und die Lebensqualität für minimalinvasiv operierte Patienten war deutlich verbessert. Auch traten weniger postoperative pulmonale Infekte auf. Des Weiteren ergab sich ein signifikant reduzierter postoperativer Krankenhausaufenthalt. Aus onkologischer Sicht zeigten sich vergleichbare Ergebnisse (Anzahl der resizierten Lymphknoten, Resektionsränder R0). Lediglich die Operationszeit war signifikant länger in der minimalinvasiv operierten Gruppe. Grundsätzlich sollte die Ösophaguschirurgie nur an spezialisierten Zentren durchgeführt werden.

Summary

The incidence of esophageal cancer has increased 7-fold over the past 30 years so that it now belongs among the most rapidly increasing tumor entities in the western world. The therapy for esophageal cancer is embedded within a multimodal concept and involves not only surgical resection together with endoscopic procedures but also radiotherapy and chemotherapy. Open resections in the esophagus are accompanied by a high postoperative morbidity. Thus, in the past years minimally invasive procedures as well as robot-assisted surgical interventions have become established. Studies have demonstrated a significant advantage of minimally invasive resections: postoperative pain is less, the convalescence times are shorter and the quality of life is markedly better for the patient after minimally invasive surgery. There are also less postoperative pulmonary infections. In addition, the postoperative hospitalization times are significantly shorter. From the oncological point of view comparable results are obtained (number of resected lymph nodes, R0 resection margins). Solely the operating time is significantly longer in the minimally invasive surgery group. As a general rule esophageal surgery should only be undertaken in specialized centers.

Key words

Minimally invasive surgery - esophageal cancer - esophagectomy - thoracoscopic esophageal resection - hybrid operations - anastomosis

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