经膈肌与经胸食管癌手术疗效比较的Meta分析

Meta analysis of comparison between transdiaphramatic and transthoracic for esophageal operation

食管癌患者相对5年生存率在过去的30年中得到了提高,这可能与手术技术提高、系统放化疗方案改进以及综合治疗不断被接受等因素有关。手术治疗目前仍然是食管癌主要治疗方案的组成部分。食管癌的多种手术方案可以归为经胸入路、经膈肌入路手术两类,主要矛盾在于经胸手术手术切除更广泛,与并发症和死亡率较少的经膈手术相比是否能达到更好的预后。先前已有大量关于这些争议的验证,结论是这两种手术的任一种方案都没有证实优于另一种,在经验丰富的术者操作下患者均取得了良好的短期效果。有关文献还提示,术者经验以及医院食管癌手术管理经验是手术并发症及死亡率重要影响因素,前者可能超过了不同手术方案的选择所产生的影响。经胸、经膈肌两种手术方案的手术结果相似。

Relative 5 years survival rates for patients has improved over the past three decades, probably link to a combi- nation of improved surgical outcomes, progress in systemic chemotherapy and radiotherapy, and the increasing acceptance of multimodality treatment. Surgical treatment remains a fundamental component of the treatment of localized esophageal adenocarcinoma. Multiple approaches have been described for esophageetomy, which can be thematically grouped under two major categories, either transthoracic or transhiatal. The through thoracotomy provides superior oneologieal outcomes main controversy rests on whether a more extended resection as opposed to resection with relatively limited morbidity and mortality through a transhiatal approach. After numerous trials have addressed these issues, neither approach has consis- tently proved to be superior than the other one, and both can provide excellent short-term results in the hands of experi- enced surgeons. Moreover, the available literature suggests that experience of the surgeonand hospital in the surgical man- agement of esophageal cancer is an important factor for operative morbidity and mortality rates, which earl supersede the type of approach selected. Oncological outcomes appear to be similar after both procedures.