Geschichte des operativen Oesophagusersatzes
ABSTRACT Zu Beginn des 20. Jahrhunderts wurde von Chirurgen vielfach der Versuch eines operativen Oesophagusersatzes vorgenommen.
Zunächst wurden diese Operationen in palliativer Intention durchgeführt, um bei den Patienten die Ernährung zu gewährleisten.
Rückschläge durch fehlende Erfahrung in der Thoraxchirurgie und Anaesthesie, Infektionsprobleme und technische Schwierigkeiten
führten zu verschiedenen Lösungsansätzen. Erste Erfolge konnten durch Bildung eines Magenschlauchs mit abdominocollarem Hochzug
und collarer Anastomose verzeichnet werden. Es wird die Geschichte des chirurgischen Oesophagusersatzes zeitlich detalliert
bis in die Gegenwart dargestellt und die Entwicklung diskutiert.
At the beginning of the twentieth century, surgeons often attempted operative esophagus replacement. At first, these operations
had a palliative intent to help the patients eat. Setbacks because of lack of experience in thorax surgery, infection problems
and technical difficulties led to different approaches to a solution. The first successes occurred when a stomach tube was
formed with a abdominocollar high course and collar anastomosis. The history of surgical replacement of the esophagus is given
in detail to the present day and the development is discussed.
Article: Esophagectomy without thoracotomy.[Show abstract] [Hide abstract]
ABSTRACT: It should be understood that esophagectomy without thoracotomy is not a surgical procedure for the treatment of a particular esophageal lesion but is only a surgical aid. Therefore, it is extremely important to discuss the specific indications for using this technique to treat a particular esophageal disorder. The technique of esophagectomy without thoracotomy should not be used for malignant lesions of the thoracic esophagus except under particular circumstances, such as resection of a carcinoma in an extremely early stage or palliative resection of advanced carcinoma of the thoracic esophagus without local invasion. Esophagectomy without thoracotomy is extremely useful for the treatment of esophageal or esophagus-related lesions, such as hypopharyngeal carcinoma, benign stricture of the esophagus, or even some carcinomas of the lower esophagus and cardia of the stomach.Surgery annual 02/1981; 13:109-21.
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ABSTRACT: Surgery is a crucial part of therapy of oesophageal cancer. The many trials which are described focus on variations in surgical technique. A trend is found that results are better with more extensive procedures. Local control evidently is improved, but an effect on survival is not yet sufficiently shown. Combinations of neoadjuvant radiotherapy and/or chemotherapy with surgery are effective by downstaging offering seemingly better survival in responding patients. Interpretation of trial data, however, is difficult because of the relatively small numbers in individual studies; the differences of the used treatment modalities make an overview approach less reasonable. Great attention should be given in the future trial work to better standardization (interpretation of definitions). Directives for optimal staging should be described in all study protocols.European Journal of Surgical Oncology 09/1996; 22(4):317-23. DOI:10.1016/S0748-7983(96)90044-X · 2.89 Impact Factor
Article: Surgery for esophageal carcinoma.[Show abstract] [Hide abstract]
ABSTRACT: From 1975 through 1988, 257 patients with carcinoma of the thoracic esophagus have been treated in our Department. Operability was 90% (232/257), overall resectability 77% (198/257) and for the operated group 85% (198/232). Hospital mortality was 9.6% but decreased to 3% over the period 1986-1988. There were 65% squamous cell epitheliomas and 35% adenocarcinomas. pTNM staging was as follows: Stage I: 11.6%; Stage II: 23.2%; Stage III: 37.9%; Stage IV: 27.3%. Overall survival was 62.5% at 1 year, 42.4% at 2 year and 30% at 5 year. According to the pTNM staging 5-year survival was 90% for Stage I, 56% for Stage II, 15.3% for Stage III and 0 for Stage IV. There were no statistically significant differences according to tumor localisation, pathologic type, sex, age. Introducing extensive resection and extended lymphadenectomy seems to improve significantly survival in the patients in whom an operation with curative intention was performed, the 1-year survival being 90.8% versus 72%, 2-year survival: 81% versus 46%, and 5-year survival 48.5% versus 41% for respectively radical and non radical resections. Barrett adenocarcinomas have no worse prognosis than other esophageal carcinomas with a 5-year survival of 91.5% if lymphnodes negative, and a 54% overall 5-year survival. Functional results after restoration of continuity with gastric tubulation were judged excellent to very good in 86.5% at 1 year, but infra-aortic anastomoses have a much higher incidence of peptic esophagitis: 53% versus 8% for cervical anastomoses. From this study it can be concluded that in experienced hands surgery today offers the best chances for optimal staging, potential cure, and prolonged high quality palliation.Journal belge de radiologie 02/1991; 74(5):389-96.