Management of Oesophageal Carcinoma

ISBN-13: 9781447131557 / Angielski / Miękka / 2012 / 298 str.

Raymond L. Hurt

Opis

Both the investigation and treatment of cancer of the oesophagus are comprehensively presented in Management of Oesophageal Carcinoma. This information is otherwise not easily available in one source. The chapters are written by experts in the fields of anatomy, cancer research, radiology, and thoracic surgery and give up-to-date information on this difficult disease. All aspects are covered: anatomy, epidemiology, endoscopic and radiologic diagnosis, pathology, surgical treatment, radiotherapy, palliative and laser therapy, and the management of complications. Surgeons will be especially interested in the discussion of the recent technique of oesophagectomy without formal thoracotomy, and the use of stapling devices. This complete reference is ideal for all clinics and medical centers specializing in thoracic surgery or treatment of oesophageal carcinoma.

Spis treści

1 Historical Survey of Surgical Treatment.- Nineteenth Century.- Early Twentieth Century.- Early Attempts at Resection and Anastomosis.- Alternative Procedures.- Successful Transpleural Resection.- United Kingdom.- Successful Intrapleural Resection and Primary Anastomosis.- The Modern Era.- Present-day Surgical Statistics for Resection of Lower and Middle Third Oesophageal Carcinoma.- References.- 2 Surgical Anatomy.- Embryology.- Adult Anatomy.- Anatomical Relationships.- Structure of the Oesophagus.- Blood Supply.- Lymphatic Drainage.- Nerve Supply.- References.- 3 Epidemiology and Predisposing Factors.- Worldwide Occurrence.- Incidence in Men.- Incidence in Women.- Changing Frequency with Time.- Frequency amongst Migrants.- Frequency in Specific Population Groups.- Aetiology.- Genetic Factors.- Environmental Factors.- Conclusions.- References.- 4 Endoscopic Diagnosis and Intubation.- Technique.- Rigid Oesophagoscope.- Fibreoptic Oesophagoscope.- Preoperative Preparation.- Normal Endoscopic Appearances.- Pathological Appearances.- Inflammation.- Ulceration.- Stricture.- Tumour.- Therapeutic Procedures.- Biopsy.- Dilatation.- Intubation.- 5 Radiological Diagnosis and Assessment.- Diagnosis.- Early Oesophageal Cancer.- Advanced Cancer.- Other Unusual Oesophageal Malignancies.- Predisposing Conditions.- Achalasia.- Caustic Stricture.- Barrett’s Oesophagus.- Cervical Webs.- Staging of Oesophageal Carcinoma.- Computed Tomography.- Staging Systems.- Staging Criteria for Squamous Cell Oesophageal Carcinoma.- Lymph Node Staging.- Subdiaphragmatic Metastases.- Gastro-oesophageal Junction Tumours.- Ultrasound.- Magnetic Resonance Imaging (MRI).- Postoperative Assessment and Tumour Recurrence.- Early Complications.- Late Complications.- Conclusions.- References.- 6 Pathology.- Pathological Diagnosis.- Normal Histology.- Barrett’s Oesophagus (Columnar-lined Lower Oesophagus).- Squamous Cell Dysplasia and Carcinoma in situ.- Squamous Cell Carcinoma.- Adenocarcinoma.- Other Carcinomas.- Carcinomas Metastatic to the Oesophagus.- Natural History.- The Early Phase.- The Late, Advanced, Invasive Phase.- The Resected Specimen.- Allegedly Predisposing Pathological Conditions.- The Autopsy.- Staging.- Pathogenesis.- Histogenesis.- Chemical Carcinogens.- Tissue Culture Studies.- Human Papillomavirus.- Cachexia and Tumour Necrosis Factors.- DNA Analysis.- Experimental Carcinoma of the Oesophagus.- Conclusions.- References.- 7 Surgical Resection for Postcricoid Carcinoma.- Aetiology of Postcricoid Carcinoma.- Surgical Pathology.- Problems in Classification.- Rationale for Surgical Excision.- Excision of Primary Tumour.- Regional Lymph Nodes.- Techniques for Reconstruction of Hypopharynx.- Palliation.- Conclusions.- References.- 8 Surgical Resection for Intrathoracic Carcinoma.- Preoperative Assessment.- Size and Extent of Tumour.- General Fitness of Patient.- Selection of Patients for Operation.- Preoperative Treatment.- Types of Operation (with Use of Stomach).- Anaesthesia.- Surgical Approach.- Use of other Organ Substitutes.- Postoperative Management.- Pain Relief.- Fluid Replacement.- First Postoperative Day.- Second Postoperative Day.- Third and Subsequent Days.- Postoperative Complications.- Blood Loss.- Cardiac Tamponade.- Low Output State.- Pulmonary Complications.- Renal Complications.- Anastomotic Leaks.- Chylothorax.- Late Complications.- Dysphagia.- Diarrhoea.- Failure to Thrive.- Cough.- Results.- Hospital Mortality.- Late Results.- Five-year Survival.- References.- 9 Transhiatal Oesophagectomy without Formal Thoracotomy.- Historical.- Indications.- Preoperative Preparation.- Operative Approach.- Mobilisation from Below.- Gastric Mobilisation.- Approach from Above.- Combined Mobilisation from Above and Below.- Resection.- Oesophagogastrostomy.- Technical Considerations.- Closure.- Postoperative Care.- Results.- Conclusions.- References.- 10 Resection Using Stapling Instruments.- Historical Aspects.- Technique.- Results.- Anastomotic Leaks.- Strictures.- Age.- Conclusions.- References.- 11 Palliative Therapy.- Palliative Resection.- Surgical Bypass Procedures.- Disadvantages of Surgical Bypass.- Intubation.- Intubation Using the Rigid Oesophagoscope.- Surgical (Traction) Intubation.- Fibreoptic Endoscopic Intubation.- Laser Therapy.- Radiotherapy.- Chemotherapy.- Dilatation.- Gastrostomy and Oesophagostomy.- Conclusions.- References.- 12 Radiotherapy and Cytotoxic Therapy.- Historical.- Radical Radiotherapy.- Criteria for Radical Radiotherapy.- Selection of Treatment.- Treatment Technique and Dose.- Treatment Morbidity.- Results of Radiotherapy.- Recent Developments in Radiotherapy.- Chemotherapy.- Combined Modality Treatment.- Preoperative Radiotherapy.- Postoperative Radiotherapy.- Chemotherapy, Radiation and Surgery.- Palliative Treatment.- Conclusions.- References.- 13 Brachytherapy (Intracavitary Irradiation).- Technique.- Insertion.- Dose.- Patient Selection.- Results.- References.- 14 Laser Therapy.- Background.- Lasers.- Interaction between Laser Light and Living Tissue.- Indications and Aims.- Equipment.- Endoscopic Technique.- Results.- Complications.- Comparisons with Other Techniques.- Combination Therapy.- Early Oesophageal Cancer.- Laser Hyperthermia.- Photodynamic Therapy (PDT).- Summary.- References.- 15 Management of Complications of Intrathoracic Resection.- The Influence of Bacterial Flora on Postoperative Morbidity.- Pulmonary Complications.- Management.- Anastomotic Leakage.- Anatomical Considerations.- Nutritional Status.- Anastomotic Technique.- Clinical Presentation and Management of Anastomotic Leakage.- Incidence.- Presentation.- Management.- Conclusion.- Other Complications Related to Infection.- Chylothorax Following Oesophagectomy.- Cardiological Complications.- Other Complications.- Summary.- References.