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136 Huţanu I. et al.Jurnalul de Chirurgie (Iaşi), 2013, Vol. 9, Nr. 224. Gill RS, Al-Adra DP, Nagendran J et al.Treatment of gastric cancer with peritonealcarcinomatosis by cytoreductive surgery andHIPEC: a systematic review of survival,mortality, and morbidity. J Surg Oncol. 2011;104: 692-698.25. Deraco M, Baratti D, Kusamura S. Morbidityand quality of life following cytoreduction andHIPEC. Cancer Treat Res. 2007; 134: 403-418.26. Kerscher AG, Mallalieu J, Pitroff A, KerscherF, Esquivel J. Morbidity and mortality of 109consecutive cytoreductive procedures withhyperthermic intraperitoneal chemotherapy(HIPEC) performed at a community hospital.World J Surg. 2010; 34: 62-69.27. McQuellon RP, Loggie BW, Fleming RA,Russell GB, Lehman AB, Rambo TD. Qualityof life after intraperitoneal hyperthermicchemotherapy (IPHC) for peritonealcarcinomatosis. Eur J Surg Oncol. 2001; 27:65-73.28. Bonastre J, Jan P, de Pouvourville G, PocardM, Estphan G, Elias D. [Cost of anintraperitoneal chemohyperthermia (IPCH)related to cytoreductive surgery]. Ann Chir.2005; 130: 553-561.29. Kilian M, Hammerich R, Langelotz C et al.[Hyperthermic intraperitoneal chemotherapyin the German DRG system. Analysis of casecost calculations of a maximum careuniversity]. Chirurg. 2005; 81: 1005-1012.30. Chong GO, Park NY, Hong DG, Cho YL,Park IS, Lee YS. Learning curve oflaparoscopic radical hysterectomy with pelvicand/or para-aortic lymphadenectomy in theearly and locally advanced cervical cancer:comparison of the first 50 and second 50cases. Int J Gynecol Cancer. 2009; 19: 1459-1464.31. Trimbos JB, Hellebrekers BW, Kenter GG,Peters LA, Zwinderman KH. The longlearning curve of gynaecological cancersurgery: an argument for centralisation. BJOG.2000; 107: 19-23.32. Sarbu V, Maciuceanu B, Supeanu I et al.[Preliminary results for intraperitonealchemotherapy in abdominal cancers].Chirurgia (Bucureşti). 2007; 102: 549-555.
ARTICOLE DE SINTEZĂ 137Jurnalul de Chirurgie (Iaşi), 2013, Vol. 9, Nr. 2STRATEGII TERAPEUTICE ÎN CANCERUL ESOFAGIAN:ROLUL TRATAMENTULUI CHIRURGICALB. Filip , I. Huțanu, I. Radu, Maria-Gabriela Aniţei, V. ScripcariuUniversitatea de Medicină și Farmacie „Gr.T. Popa” IașiClinica I Chirurgie Oncologică, Institutul Regional de Oncologie IașiTHERAPEUTIC STRATEGIES IN OESOPHAGEAL CANCER: THE PLACE OFSURGICAL TREATEMENT (Abstract): Any attempt to define the place of surgery in thetreatement of oesophageal cancer should consider the major changes that occurred during the lasttwo decades: major shift in histologic type, improved staging methods, spectacular reduction ofoperative risk, standardization of oncologic principles of resection and the development 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 include 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 decades: limited (transhiatal esophagectomy) and extended(transthoracic esophagectomy) with two field lymphadenectomy. In the short term, transhiatalesophagectomy is accompanied by less morbidity, in the long term is preferable for tumors atgastro-oesophageal junction without involved lymph nodes of chest. For patiets suitable forsurgery, transthoracic esophagectomy with mediastinal and abdominal lymphadenectomy ispreferred. This article provides 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] Jurnalul de 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 decese anual ocupălocul 8 ca frecvenţă în lume şi reprezintă a 6-a cauză de deces prin cancer [1].Majoritatea cancerelor esofagiene suntreprezentate de carcinoame scuamocelularesau de adenocarcinoame; un număr redus decazuri includ leiomiosarcoamele, tumorilestromale sau tumori nediferențiate.În zona cu risc maxim, ce se întindedin partea nordică a Iranului, trecând prinAsia centrală până în zona de nord a Chinei,majoritatea cazurilor sunt reprezentate decarcinoamele scuamocelulare [2]. Factorii derisc majori în dezvoltarea acestui tip detumoră nu sunt complet cunoscuți, dar secrede că statusul nutriţional precar,consumul scăzut de fructe şi vegetale, şiconsumul de băuturi alcoolice la temperaturicrescute ar avea un rol important.În zonele cu risc scazut, cum ar fiEuropa de Vest și nordul Americii se pare căfumatul şi consumul de alcool sunt întâlnitela peste 90% din cazurile de cancerescuamocelulare [3].Ratele de incidență pentru cele douătipuri majore de CE prezintă variații istoriceReceived date: 28.02.2013Accepted date: 10.03.2013Adresa de corespondenţă: Dr. Bogdan FilipClinica I Chirurgie Oncologică, Institutul Regional de Oncologie IaşiStr. General Henry Mathias Berthlot nr. 2-4, 700483, IaşiTel.: 0040 (0) 745 25 31 49E-mail: bfilip79@yahoo.com
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