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ARTICOLE DE SINTEZĂ 137<strong>Jurnalul</strong> <strong>de</strong> <strong>Chirurgie</strong> (Iaşi), 2013, Vol. 9, Nr. 2STRATEGII TERAPEUTICE ÎN CANCERUL ESOFAGIAN:ROLUL TRATAMENTULUI CHIRURGICALB. Filip , I. Huțanu, I. Radu, Maria-Gabriela Aniţei, V. ScripcariuUniversitatea <strong>de</strong> Medicină și Farmacie „Gr.T. Popa” IașiClinica I <strong>Chirurgie</strong> Oncologică, Institutul Regional <strong>de</strong> Oncologie IașiTHERAPEUTIC STRATEGIES IN OESOPHAGEAL CANCER: THE PLACE OFSURGICAL TREATEMENT (Abstract): Any attempt to <strong>de</strong>fine the place of surgery in thetreatement of oesophageal cancer should consi<strong>de</strong>r the major changes that occurred during the lasttwo <strong>de</strong>ca<strong>de</strong>s: major shift in histologic type, improved staging methods, spectacular reduction ofoperative risk, standardization of oncologic principles of resection and the <strong>de</strong>velopment ofmultimodality therapeutic strategies. Surgical treatement plays an essential role in management ofesophageal cancer and it is prefferable to be done by trained surgical teams in large volumecenters. Optimal surgical treatment strategies inclu<strong>de</strong> appropriate patient selection, accuratestaging, and risk assesment, selection of appropriate surgical approach, and the use ofmultimodality treatement.Esophagectomy remaines the main treatement of esophageal carcinoma,but in half of cases patients are unresectable at the time of diagnosis due to presence of systemicdisease.Two major surgical strategies to improve survival rates after esophagectomy haveemerged during the past <strong>de</strong>ca<strong>de</strong>s: limited (transhiatal esophagectomy) and exten<strong>de</strong>d(transthoracic esophagectomy) with two field lympha<strong>de</strong>nectomy. In the short term, transhiatalesophagectomy is accompanied by less morbidity, in the long term is preferable for tumors atgastro-oesophageal junction without involved lymph no<strong>de</strong>s of chest. For patiets suitable forsurgery, transthoracic esophagectomy with mediastinal and abdominal lympha<strong>de</strong>nectomy ispreferred. This article provi<strong>de</strong>s un up-to-date of options for surgical managing of esophagealcancer and outlines of surgical technique.KEY WORDS: ESOPHAGEAL CANCER; SURGERY; LYMPHADENECTOMY; SURVIVALSHORT TITLE: Cancerul esofagian – rolul tratamentului chirurgicalEsophagian cancer – place of surgeryHOW TO CITE:țanu I, Radu I, Aniţei MG, Scripcariu V. [Therapeutic strategies in oesophageal cancer: theplace of surgical treatement] <strong>Jurnalul</strong> <strong>de</strong> chirurgie (Iaşi). 2013; 9(2): 137-148. DOI: 10.7438/1584-9341-9-2-4.INTRODUCERECancerul esofagian (CE) cu 482.300cazuri noi şi 406.800 <strong>de</strong>cese anual ocupălocul 8 ca frecvenţă în lume şi reprezintă a 6-a cauză <strong>de</strong> <strong>de</strong>ces prin cancer [1].Majoritatea cancerelor esofagiene suntreprezentate <strong>de</strong> carcinoame scuamocelularesau <strong>de</strong> a<strong>de</strong>nocarcinoame; un număr redus <strong>de</strong>cazuri includ leiomiosarcoamele, tumorilestromale sau tumori nediferențiate.În zona cu risc maxim, ce se întin<strong>de</strong>din partea nordică a Iranului, trecând prinAsia centrală până în zona <strong>de</strong> nord a Chinei,majoritatea cazurilor sunt reprezentate <strong>de</strong>carcinoamele scuamocelulare [2]. Factorii <strong>de</strong>risc majori în <strong>de</strong>zvoltarea acestui tip <strong>de</strong>tumoră nu sunt complet cunoscuți, dar secre<strong>de</strong> că statusul nutriţional precar,consumul scăzut <strong>de</strong> fructe şi vegetale, şiconsumul <strong>de</strong> băuturi alcoolice la temperaturicrescute ar avea un rol important.În zonele cu risc scazut, cum ar fiEuropa <strong>de</strong> Vest și nordul Americii se pare căfumatul şi consumul <strong>de</strong> alcool sunt întâlnitela peste 90% din cazurile <strong>de</strong> cancerescuamocelulare [3].Ratele <strong>de</strong> inci<strong>de</strong>nță pentru cele douătipuri majore <strong>de</strong> CE prezintă variații istoriceReceived date: 28.02.2013Accepted date: 10.03.2013Adresa <strong>de</strong> corespon<strong>de</strong>nţă: Dr. Bogdan FilipClinica I <strong>Chirurgie</strong> Oncologică, Institutul Regional <strong>de</strong> Oncologie IaşiStr. General Henry Mathias Berthlot nr. 2-4, 700483, IaşiTel.: 0040 (0) 745 25 31 49E-mail: bfilip79@yahoo.com