Current Status of Management of Malignant Disease: Current Management of Esophageal Cancer
Current Status of Management of Malignant Disease: Current Management of Esophageal Cancer
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DOI：
10.1007/s11605-014-2701-3
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发表时间：
2015-05-01
影响因子：
3.2
通讯作者：
Ferri, Lorenzo E.
中科院分区：
文献类型：
--
作者：
Cools-Lartigue, Jonathan;Spicer, Jonathan;Ferri, Lorenzo E.
本研究的目的是概述有关食管癌手术治疗的证据，并提供有关其实施的单一机构纲要。食管癌是全世界癌症相关发病率和死亡率的主要原因。手术在其治疗中继续发挥重要作用，并为局部和局部晚期疾病提供最佳的治愈机会。然而，对于该患者群体的最佳治疗策略存在相当大的争议。此外，尽管手术和围手术期护理取得了进步以及微创方法的出现，但大多数患者在根治性切除后仍死于远处转移。这一失败凸显了多模式、分阶段治疗在新诊断食管肿瘤患者治疗中的重要性。在此，我们对食管癌患者可用的诊断检查以及局部和全身治疗方案进行了全面的、基于证据的综述。概述并讨论了支持围手术期化疗与放化疗的证据。此外，我们还强调了我们根据临床表现阶段进行诊断评估、手术选择策略和围手术期治疗方案选择的机构方法。最后，我们讨论加速康复在这一复杂患者群体术后管理中的作用。食管癌仍然是一种死亡率很高的毁灭性疾病。良好的结果需要多模式、分阶段的治疗方法。
The objective of this study is to outline the evidence regarding the surgical management of esophageal cancer and provide a single institutional outline regarding its implementation.Esophageal cancer is a major cause of cancer-related morbidity and mortality worldwide. Surgery continues to play an important role in its management and offers the best chance for cure in localized and locally advanced disease. However, considerable controversy exists regarding the optimum treatment strategy in this patient population. Furthermore, despite advances in operative and perioperative care and the advent of minimally invasive approaches, the majority of patients succumb to distant metastases after curative intent resection. This failure highlights the importance of multimodal, stage-directed therapy in the management of patients with newly diagnosed esophageal tumors.Herein, we provide a comprehensive, evidence-based review of the diagnostic workup and locoregional and systemic treatment options available to esophageal cancer patients. The evidence supporting perioperative chemotherapy versus chemoradiotherapy is outlined and discussed. In addition, we highlight our institutional approach to the diagnostic evaluation, operative selection strategy, and perioperative treatment regimen selection based on the stage of presentation. Finally, we discuss the role of enhanced recovery in the postoperative management of this complex group of patients.Esophageal cancer remains a devastating disease with high mortality. Favorable outcomes mandate a multimodal, stage-directed treatment approach.