胸部食道癌に対する外科治療の現況

概要

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Esophageal squamous cell carcinoma is the sixth most common cause of cancer death in Japan. Surgery was previously the mainstay of treatment, but because of high rates of local and systemic recurrence, multidisciplinary management is being evaluated. In this article, we introduce the recent addition of neoadjuvant chemotherapy to the surgical management of resectable esophageal squamous cell carcinoma, clinical stage II and III, following the randomized control trial JCOG 9907. Neoadjuvant chemoradiotherapy has recently been approved for esophageal squamous cell carcinoma because it offers an opportunity for marginnegative resection, improved locoregional control, and increased survival rate. Less-invasive endoscopic procedures, such as thoracoscopic esophagectomy and laparoscopy-assisted gastric tube reconstruction, are options for the resection of noninvasive esophageal cancer. We performed thoracoscopic esophageal mobilization with the patient in the prone position. Compared with esophagectomy with right trans-thoracotomy, thoracoscopic esophagectomy has the advantage of a lower incidence of respiratory complications, which are a significant predictor of postoperative mortality. Additionally, other recent surgical treatments are described.
日本医科大学医学会の論文