食管癌全食管系膜切除术的现状

食管癌外科中关于手术方式和淋巴结清扫范围仍存在相当大的争议。近年来食管癌全食管系膜切除术的概念倍受重视。全食管系膜切除术代表着一种手术原则而非手术方式，可在各种开放以及微创食管切除术中应用。全食管系膜切除术适用于T1-T3期食管癌。结合二野或三野淋巴结清扫，全食管系膜切除术旨在获得食管癌的R0切除。外科切缘（尤其是径向切缘）和切除淋巴结数目是评价手术质量的重要指标。

Department of Thoracic Surgery,Zhejiang Cancer Hospital,Hangzhou 310022, China

Considerable debates still exist in terms of surgical approach and extent of lymphadenectomy in esophageal cancer surgery. More importance has been attached to the concept of total mesoesophageal excision(TME) for esophageal carcinoma in recent years. TME represents an operative principle rather than a surgical approach, which could be used in various open as well as minimally invasive esophagectomies. TME is indicated in stage T1-T3 esophageal carcinoma. Combining with 2-field or 3-field lymphadenectomy, TME aims to obtain R0 resection in the surgical treatment of esophageal carcinoma. Both the surgical resection margin (especially radial margin) and the number of resected lymph nodes are important indicators to evaluate surgical quality.