関: esophagectomy

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/09/06 16:38:37」(JST)

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Esophagectomy (US English) or Oesophagectomy (British English) is the surgical removal of all or part of the esophagus.

Purpose[edit source | edit]

The principal objective is to remove the esophagus, a part of the gastrointestinal tract ("food pipe"). This procedure is usually done for patients with esophageal cancer. It is normally done to remove cancerous tumors from the body. It is best done when an esophageal cancer is detected early, before it has spread. If taken up early enough, an esophagectomy might prove to be life saving. Despite significant improvements in technique and postoperative care, the long term survival for esophageal cancer is still poor. Currently multimodality treatment is needed (chemotherapy and radiation therapy) for advanced tumors. Esophagectomy is also occasionally performed for benign disease such as esophageal atresia in children, achalasia, or caustic injury.

Classification[edit source | edit]

There are two main types of esophagectomy.

A transhiatal esophagectomy (THE) is performed on the neck and abdomen simultaneously.^[1]

A transthoracic esophagectomy (TTE) involves opening the thorax (chest).

In most cases, the stomach is transplanted into the neck and the stomach takes the place originally occupied by the esophagus. In some cases, the removed esophagus is replaced by another hollow structure, such as the patient's colon.

Another option which is slowly becoming available is minimally invasive surgery (MIS) which is performed laparoscopically and thoracoscopically.

After surgery, patients may have trouble with a regular diet and may have to consume softer foods, avoid liquids at meals, and stay upright for 1–3 hours after eating. Dysphagia is common and patients are encouraged to chew foods very well or grind their food. Patients may complain of substernal pain that resolves by sipping fluids or regurgitating food. Reflux-type symptoms can be severe, including intolerance to acidic foods and large, fatty meals. Jejunal feeding tubes may be placed during surgery to provide a temporary route of nutrition until oral eating resumes.

Process[edit source | edit]

Esophagectomy is a very complex operation that can take between 4 and 8 hours to perform. It is best done exclusively by doctors who specialise in upper gastrointestinal surgery. Anesthesia for an esophagectomy is also complex, owing to the problems with managing the patient's airway and lung function during the operation. Lung collapse is highly probable as well as losing function of diaphragm and possible injury of the spleen.

Average mortality rates (deaths either in hospital or within 30 days of surgery) for the operation are around 10% in US hospitals. However recognized major cancer hospitals typically report mortality rates under 5%.

Major complications occur in 10-20% of patients, and some sort of complication (major and minor) occurs in 40%. Time in hospital is usually 1–2 weeks and recovery time 3–6 months. It is possible for the recovery time to take up to a year.

References[edit source | edit]

^ Davies AR, Forshaw MJ, Khan AA, et al. (2008). "Transhiatal esophagectomy in a high volume institution". World journal of surgical oncology 6 (1): 88. doi:10.1186/1477-7819-6-88. PMC 2531176. PMID 18715498.

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1. 切除可能食道癌のマネージメントにおける外科腫瘍学の原則 surgical oncologic principles for management of resectable esophageal cancer
2. 食道切除術：合併症およびマネージメント esophagectomy complications and management
3. 食道表在癌のマネージメント management of superficial esophageal cancer
4. 限局進行性の切除不能食道癌のマネージメント management of locally advanced unresectable esophageal cancer
5. 食道穿孔の外科的マネージメント surgical management of esophageal perforation

English Journal

MicroRNA profiling in locally advanced esophageal cancer indicates a high potential of miR-192 in prediction of multimodality therapy response.

Odenthal M, Bollschweiler E, Grimminger PP, Schröder W, Brabender J, Drebber U, Hölscher AH, Metzger R, Vallböhmer D.SourceInstitute of Pathology, University of Cologne, Cologne, Germany.
International journal of cancer. Journal international du cancer.Int J Cancer.2013 Nov 15;133(10):2454-63. doi: 10.1002/ijc.28253. Epub 2013 Jun 3.
To identify possible predictive markers, our study aimed to characterize microRNA (miRNA) profiles of responder and nonresponder in the multimodality therapy of locally advanced esophageal cancer. Initially, a microarray-based approach was performed including eight patients with esophageal cancer. P
PMID 23649428

Surgical Resection of a Solitary Pulmonary Metastasis from Basaloid Squamous Cell Carcinoma of the Esophagus: A Case Report.

Kosaka T, Mogi A, Yamaki E, Miyazaki T, Kuwano H.SourceDepartment of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia.Ann Thorac Cardiovasc Surg.2013 Oct 3. [Epub ahead of print]
Basaloid squamous cell carcinoma (BSCC) of the esophagus is a relatively rare variant of esophageal malignancies. It is regarded as a disease with a poor prognosis because of the high frequency of distant metastases. We managed a case of resected solitary pulmonary metastasis of BSCC of the esophagu
PMID 24088918

Minimally invasive oesophagectomy more expensive than open despite shorter length of stay.

Dhamija A, Dhamija A, Hancock J, McCloskey B, Kim AW, Detterbeck FC, Boffa DJ.SourceDepartment of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA.
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.Eur J Cardiothorac Surg.2013 Oct 3. [Epub ahead of print]
OBJECTIVES: The minimally invasive oesophagectomy (MIO) approach offers a number of advantages over open approaches including reduced discomfort, shorter length of stay and a faster recovery to baseline status. On the other hand, minimally invasive procedures typically are longer and consume greater
PMID 24092502

Japanese Journal

Laparoscopically assisted transhiatal esophagectomy with esophagogastroplasty for post-corrosive esophageal stricture treatment in children

SHALABY Rafik,SHAMS Abdelmonaem,SOLIMAN Soliman Mohamed,SAMAHA Abelhady,IBRAHIM Hossam Abdelrazek
Pediatric surgery international 23(6), 545-549, 2007-06-01
NAID 10027857038

Effect of Substituting Allogenic Blood Transfusion with Autologous Blood Transfusion on Outcomes after Radical Oesophagectomy for Cancer

TAKEMURA Masashi,OSUGI Harushi,HIGASHINO Masayuki,TAKADA Nobuyasu,LEE Sigeru,KINOSHITA Hiroaki
Annals of thoracic and cardiovascular surgery 11(5), 293-300, 2005-10-01
NAID 10027076702