به نام خالق
اعمال جراحی نوین در کانسرهای قسمت های مختلف مری
دکتر پرویز فالح عابد
دانشیار دانشگاه علوم پزشکی قزوین
Figure 1. Patient positioning and trocar
position for thoracoscopic portion.
Figure 2. Thoracoscopic exposure of the left recurrent
laryngeal nerve and lymph node dissection.
Figure 3. Thoracoscopic subcarinal lymph
Figure 4. Patient positioning and trocar
position for laparoscopic portion
Figure 5. Laparoscopic mobilization and division of
the left gastric vein and artery (A) and lymph node
Figure 6. Holistic and complete view of the
McKeown minimally invasive esophagectomy
• Esophagectomy Techniques
There are many ways to perform an esophagectomy. The method
your surgeon uses will depend on the location of your tumor.
• Transhiatal Esophagectomy
• In this method, the surgeon makes incisions in the neck and
abdomen. Most of the esophagus is removed through these incisions.
Because there’s no incision in the chest wall and the lungs do not
have to be deflated for the surgeon to reach the esophagus, this
method may result in fewer complications, such as pneumonia.
Typically the surgeon attaches the stomach to the remaining
esophagus in the neck. Sometimes, a segment of the colon is used to
connect the esophagus to the stomach.
• Ivor-Lewis Esophagectomy
In this method, the surgeon makes one incision in the
abdomen and one in the chest along the ribs. The lower half
of the esophagus is removed through the abdominal
incision, and the stomach is attached to the upper
esophagus in the chest.
• Total Esophagectomy
This surgery is used to remove the entire esophagus
when there are large tumors in the middle of the
esophagus. The surgeon makes incisions in three places:
the abdomen, chest, and neck. The esophagus is
separated from other chest structures and organs
through these incisions, and then it’s removed. The
surgeon will create a new passage for food from the
throat to the stomach, typically with a segment of the
small intestine or colon.
• Minimally Invasive Surgery
For many patients, surgeons can use a minimally
invasive approach to remove the part of the esophagus
affected by cancer.
Table 1. Demographics and clinicopathological parameters (n = 142).
Table 2. Operative and post-operative parameters.
Table 3. Post-operative complications
Figure 7. Disease-free survival (A) and overall survival (B) of patients
presenting with esophageal cancer who received the McKeown minimally
invasive esophagectomy procedure.