به نام خالق هستی

Esophageal cancer

اعمال جراحی نوین در کانسرهای قسمت های مختلف مری

دکتر پرویز فالح عابددانشیار دانشگاه علوم پزشکی

قزوین

Figure 1. Patient positioning and trocar position for thoracoscopic portion.

Figure 2. Thoracoscopic exposure of the left recurrent laryngeal nerve and lymph node dissection.

Figure 3. Thoracoscopic subcarinal lymph node dissection

Figure 4. Patient positioning and trocar position for laparoscopic portion

Figure 5. Laparoscopic mobilization and division of the left gastric vein and artery (A) and lymph node dissection (B).

Figure 6. Holistic and complete view of the McKeown minimally invasive esophagectomy procedure.

• Esophagectomy Techniques

There are many ways to perform an esophagectomy. The method your surgeon uses

will depend on the location of your tumor.

• Transhiatal Esophagectomy• In this method, the surgeon makes incisions in the

neck and abdomen. Most of the esophagus is removed through these incisions. Because there’s no incision in the chest wall and the lungs do not have to be deflated for the surgeon to reach the esophagus, this method may result in fewer complications, such as pneumonia. Typically the surgeon attaches the stomach to the remaining esophagus in the neck. Sometimes, a segment of the colon is used to connect the esophagus to the stomach.

• Ivor-Lewis EsophagectomyIn this method, the surgeon makes one incision in the abdomen and one in the chest along the ribs. The lower half of the esophagus is removed through the abdominal incision, and the stomach is attached to the upper esophagus in the chest.

• Total EsophagectomyThis surgery is used to remove the entire esophagus when there are large tumors in the middle of the esophagus. The surgeon makes incisions in three places: the abdomen, chest, and neck. The esophagus is separated from other chest structures and organs through these incisions, and then it’s removed. The surgeon will create a new passage for food from the throat to the stomach, typically with a segment of the small intestine or colon.

• Minimally Invasive SurgeryFor many patients, surgeons can use a minimally invasive approach to remove the part of the esophagus affected by cancer.

Table 1. Demographics and clinicopathological parameters (n = 142).

Table 2. Operative and post-operative parameters.

Table 3. Post-operative complications

Figure 7. Disease-free survival (A) and overall survival (B) of patients presenting with esophageal cancer who received the McKeown minimally invasive esophagectomy procedure.