腔镜手术在食管胃结合部腺癌新辅助治疗后的应用

Current status and progression of minimally invasive surgery after neoadjuvant therapy foradenocarcinoma of esophagogastric junction

食管胃结合部腺癌(AEG)腔镜手术数量逐年提升,其手术径路、淋巴结清扫、消化道重建等技术要点也日趋成熟,而伴随着新辅助治疗循证医学证据的出现,进展期AEG采用新辅助化疗或新辅助放化疗的治疗方案也逐步为大多数外科和肿瘤科医师所接受。欧洲国家的学者较早地开展了针对食管癌和AEG在新辅助治疗后腔镜手术的探索和尝试,国内学者也通过胃肠外科和胸外科医师的合作,对新辅助治疗在AEG中的应用提出了可行性的建议,体现了规范化、标准化、个体化的趋势。但在完成新辅助治疗后,是否还能选择腔镜手术以及新辅助治疗后患者的腔镜手术技术操作要点、消化重建模式、近期和远期安全性等问题,尚无统一的标准,相关问题更是成为近年来争议的热点和探讨的方向。本文从目前AEG新辅助治疗的进展,以及欧美和东亚地区包括我国,在新辅助治疗后实施腔镜手术的现状、相关研究和未来前景进行阐述,以期更好地指导临床工作。

The number of minimally invasive surgery(MIS)for adenocarcinoma of esophagogastric junction(AEG)has been increasing year by year.The key technical points such as surgical approach,lymph node dissection and GI tract reconstruction have gradually reached their maturity.With the emergence of proofs of evidence⁃based neoadjuvant therapy,neoadjuvant chemotherapy or neoadjuvant radiochemotherapy for advanced AEG is also gradually accepted by most surgeons and oncologists.European scholars have previously started researches on MIS after neoadjuvant therapy for esophageal cancer and AEG.Domestic scholars also raise practical suggestions on the application of neoadjuvant therapy for AEG via the cooperation between gastrointestinal and thoracic surgeons,demonstrating the trend in standardization and individualization.But there is still no consent to the indication of MIS after neoadjuvant therapy.Furthermore,there is also a lack of the standardization of technical points for MIS,GI tract reconstruction,short⁃and long⁃term outcomes.Such associated problems have been the hot controversy and exploration in recent years.This article describes current progress of neoadjuvant therapy for AEG,current status of MIS after the neoadjuvant therapy in Europe,America,East Asia,including China,and related researches plus future prospects,hoping for better clinical outcomes.