Esophageal cancer surgery: Difference between revisions
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===Esophagectomy=== | ===Esophagectomy=== | ||
The disease must be localised in order for it to be operable, which is the case in 20-30% of patients. If a tumor is particularly large but still localised, it may be shrunk down first using chemotherapy and/or radiotherapy until the tumor becomes of a size that is operable. Removing a segment of the esophagus is called an esophagectomy. The procedure shortens the distance between the pharynx and the stomach. The stomach, or some other part of the gastrointestinal tract, such as the colon, is brought up into the chest cavity where it is interposed. <ref name="Deschamps_2005">{{cite journal |author=Deschamps C, Nichols FC, Cassivi SD, et al. |title=Long-term function and quality of life after esophageal resection for cancer and Barrett’s |journal=Surgical Clinics of North America |volume=85 |issue=3 |pages=649-656 |year=2005 |pmid=15927658}}</ref> | |||
The optimal surgical procedure is controversial. One approach | The optimal surgical procedure is controversial. One approach promotes the transhiatal esophagectomy with anastomosis of the [[stomach]] to the [[cervical esophagus]] technique. A second approach advocates abdominal mobilization of the [[stomach]] and transthoracic excision of the esophagus with anastomosis of the [[stomach]] to the upper thoracic esophagus or the cervical esophagus.<ref name="pmid11585510">{{cite journal |vauthors=Triboulet JP, Mariette C, Chevalier D, Amrouni H |title=Surgical management of carcinoma of the hypopharynx and cervical esophagus: analysis of 209 cases |journal=Arch Surg |volume=136 |issue=10 |pages=1164–70 |year=2001 |pmid=11585510 |doi= |url=}}</ref> | ||
<ref name="pmid16615159">{{cite journal |vauthors=Wang HW, Chu PY, Kuo KT, Yang CH, Chang SY, Hsu WH, Wang LS |title=A reappraisal of surgical management for squamous cell carcinoma in the pharyngoesophageal junction |journal=J Surg Oncol |volume=93 |issue=6 |pages=468–76 |year=2006 |pmid=16615159 |doi=10.1002/jso.20472 |url=}}</ref> | |||
===Laser therapy=== | ===Laser therapy=== | ||
Revision as of 14:45, 7 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]Hadeel Maksoud M.D.[3]
Overview
The predominant therapy for esophageal cancer is surgical resection. Adjunctive chemotherapy and radiation may be required.
Surgery
Stage 0 Esophageal Cancer
Stage 0 squamous esophageal cancer is rarely seen in the United States, but surgery has been used for this stage of cancer[1]
Stage I Esophageal Cancer
Standard treatment options:
- Chemoradiation with subsequent surgery
- Surgery
Stage II Esophageal Cancer
Standard treatment options:
- Chemoradiation with subsequent surgery
- Chemoradiation alone
- Surgery alone
Stage III Esophageal Cancer
Standard treatment options:
- Chemoradiation with subsequent surgery
- Chemoradiation alone
Stage IV Esophageal Cancer
At diagnosis, approximately 50% of patients with esophageal cancer will have metastatic disease and will be candidates for palliative therapy.
Standard treatment options:
- Chemoradiation with subsequent surgery (for patients with stage IVA disease)
- Endoscopic-placed stents to provide palliation of dysphagia
- Radiation therapy with or without intraluminal intubation and dilation
- Intraluminal brachytherapy to provide palliation of dysphagia
- Nd:YAG endoluminal tumor destruction or electrocoagulation
- Chemotherapy has provided partial responses for patients with metastatic distal esophageal adenocarcinoma[2]
Stenting
If the patient cannot swallow at all, a stent may be inserted to keep the esophagus patent; stents may also assist in occluding fistulas. A nasogastric tube may be necessary to continue feeding while treatment for the tumor is given, and some patients require a gastrostomy (feeding hole in the skin that gives direct access to the stomach). The latter two are especially important if the patient tends to aspirate food or saliva into the airways, predisposing for aspiration pneumonia.
Esophagectomy
The disease must be localised in order for it to be operable, which is the case in 20-30% of patients. If a tumor is particularly large but still localised, it may be shrunk down first using chemotherapy and/or radiotherapy until the tumor becomes of a size that is operable. Removing a segment of the esophagus is called an esophagectomy. The procedure shortens the distance between the pharynx and the stomach. The stomach, or some other part of the gastrointestinal tract, such as the colon, is brought up into the chest cavity where it is interposed. [3]
The optimal surgical procedure is controversial. One approach promotes the transhiatal esophagectomy with anastomosis of the stomach to the cervical esophagus technique. A second approach advocates abdominal mobilization of the stomach and transthoracic excision of the esophagus with anastomosis of the stomach to the upper thoracic esophagus or the cervical esophagus.[4] [5]
Laser therapy
Laser therapy is the use of high-intensity light to destroy tumor cells; it affects only the treated area. This is typically done if the cancer cannot be removed by surgery. The relief of a blockage can help to reduce dysphagia and pain. Photodynamic therapy (PDT), a type of laser therapy, involves the use of drugs that are absorbed by cancer cells; when exposed to a special light, the drugs become active and destroy the cancer cells.
Radiotherapy
Radiotherapy is given before, during or after chemotherapy or surgery, and sometimes on its own to control symptoms. In patients with localized disease but contraindications to surgery, "radical radiotherapy" may be used with curative intent.
References
- ↑ Affleck DG, Karwande SV, Bull DA, Haller JR, Stringham JC, Davis RK (2000). "Functional outcome and survival after pharyngolaryngoesophagectomy for cancer". Am. J. Surg. 180 (6): 546–50. PMID 11182415.
- ↑ "Esophageal Cancer Treatment".
- ↑ Deschamps C, Nichols FC, Cassivi SD; et al. (2005). "Long-term function and quality of life after esophageal resection for cancer and Barrett's". Surgical Clinics of North America. 85 (3): 649–656. PMID 15927658.
- ↑ Triboulet JP, Mariette C, Chevalier D, Amrouni H (2001). "Surgical management of carcinoma of the hypopharynx and cervical esophagus: analysis of 209 cases". Arch Surg. 136 (10): 1164–70. PMID 11585510.
- ↑ Wang HW, Chu PY, Kuo KT, Yang CH, Chang SY, Hsu WH, Wang LS (2006). "A reappraisal of surgical management for squamous cell carcinoma in the pharyngoesophageal junction". J Surg Oncol. 93 (6): 468–76. doi:10.1002/jso.20472. PMID 16615159.