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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/08/14 14:14:14」(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.

UpToDate Contents

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1. 食道切除術：合併症およびマネージメント esophagectomy complications and management
2. 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
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. バレット食道のマネージメント management of barretts esophagus

English Journal

Scintigraphic Identification of Gastric Tissue in a Mediastinal Mass.

Mainta IC1, Montet X, Willi JP, Dulguerov P, Rager O.
Clinical nuclear medicine.Clin Nucl Med.2016 Mar;41(3):207-8. doi: 10.1097/RLU.0000000000001078.
We present a Tc pertechnetate scintigraphy performed in a 64-year-old woman to investigate a mediastinal cystic mass in search of residual gastric mucosa after gastrectomy. She had a history of esophagectomy and gastric pull-up for esophageal cancer. Postoperative leakage necessitated ablation of th
PMID 26571450

Staging of adenocarcinoma of the gastroesophageal junction.

Parry K1, Haverkamp L2, Bruijnen RC3, Siersema PD4, Offerhaus GJ5, Ruurda JP2, van Hillegersberg R6.
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.Eur J Surg Oncol.2016 Mar;42(3):400-6. doi: 10.1016/j.ejso.2015.11.014. Epub 2015 Dec 6.
BACKGROUND: Clinical staging of adenocarcinoma of the gastroesophageal junction (GEJ) determines the curative treatment regimen containing either neoadjuvant chemotherapy or chemoradiotherapy followed by either gastrectomy or esophagectomy. The value of current diagnostic tools is a matter of debate
PMID 26777127

Safety and benefit of curative surgical resection for esophageal squamous cell cancer associated with multiple primary cancers.

Otowa Y1, Nakamura T2, Takiguchi G2, Yamamoto M2, Kanaji S2, Imanishi T3, Oshikiri T2, Suzuki S2, Tanaka K4, Kakeji Y2.
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.Eur J Surg Oncol.2016 Mar;42(3):407-11. doi: 10.1016/j.ejso.2015.11.012. Epub 2015 Dec 10.
BACKGROUND: Enhancements in surgical techniques have led to improved outcomes for esophageal cancer. Recent findings have showed that esophageal cancer is frequently associated with multiple primary cancers, and surgical resection is usually complicated in such cases. The aim of this study was to cl
PMID 26733367