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Carcinoma of the Esophagus - part 8

Mặc dù cải tiến trong dàn dựng, chẩn đoán và điều trị, kết quả cho bệnh nhân ung thư thực quản vẫn còn nghèo. Mặc dù sự sống còn 1 năm đã được cải thiện trong những năm gần đây, đã có thay đổi nhỏ trong | 106 S. C. Rankin 78. P. Flamen T. Lerut E. Van Cutsem et al. The utility of positron emission tomography PET for the diagnosis staging of recurrent esophageal cancer. J Thorac Cardiovasc Surg 120 2000 1085-92. 79. H. Kato T. Miyazaki M. Nakajima et al. Value of positron emission tomography in the diagnosis of recurrent esophageal carcinoma. Br J Surg 91 2004 1004-9. 80. J. D. Zhang J. M. Yu H. B. Guo et al. Clinical value of positron emission tomography-CT for the diagnosis of postoperative recurrence and metastasis in the patients with oesophageal cancer Article in Chinese . Zhonhua Wei Chang Wai Ke Za Zhi 9 2006 56-8. 7 The Role of Surgery in the Management of Esophageal Cancer and Palliation of Inoperable Disease Robert Mason Introduction In spite of improvements in diagnosis staging and treatment the outcome for patients with esophageal cancer remains poor. Although 1-year survival has improved in recent years there has been little change in the 5-and 10-year survival Figure 7.1 . This is because many of the patients have metastatic disease with a large percentage having micrometastases. These have been found in the bone marrow in patients undergoing resection in 88 of cases 1 . A significant factor in the improved 1-year survival is the reduction in inhospital operative mortality Table 7.1 1 2 3 4 . This relates to improvement in staging fitness testing technique perioperative care and probably most importantly centralization of services in large centers Table 7.2 5 6 7 . In a study from the United Kingdom there was a 40 reduction in operative mortality for every 10 patient increase in a surgeon s caseload. 8 . Such large centers with dedicated teams can achieve inhospital mortality figures of less than 2 by utilizing a multidisciplinary team approach 4 . Another factor in improved short-term survival is the recognition that surgery alone is not the answer for most cases and that survival benefits can accrue by the use of preoperative neoadjuvant chemotherapy