Moretti M, De Giacomo T, Francioni F, Rendina E A, Venuta F, Mercadante E, Coloni G F
Dipartimento di Chirurgia Generale, Specialità Chirurgiche e Trapianti d'organo Paride Stefanini, Cattedra di Chirurgia Toracica, Policlinico Umberto I, Università degli Studi di Roma La Sapienza, Rome, Italy.
Minerva Chir. 2002 Apr;57(2):111-5.
Esophageal surgery was recently modified by minimally-invasive approach. Personal experience with the thoracoscopic technique for esophagectomy in patients with early stage esophageal cancer is described. METHODS. From 1996 to 2000 at the Department of Thoracic Surgery of the University of Rome "La Sapienza", 10 patients, 7 male and 3 female, underwent video-thoracoscopic esophagectomy for esophageal cancer. Median age was 64 years (range 53-72). With the patient in left lateral decubitus 4 ports were positioned between the 4th and 8th intercostal space. The thoracic esophagus was mobilized in the entire length and circumference with the connective tissue and peri-esophageal nodal stations. A cervicotomy followed by a median laparotomy for tubulization of the stomach was performed.
Nobody required conversion to thoracotomy. No complication or intraoperative death were observed. The median thoracic time was 110 minutes (range 55-165). No death within 30 days after discharge was recorded. One patient presented left vocal cord paralysis. In one case a recurrence in cervical anastomosis two months after the operation was observed. One patient died after 36 month for metastatic spread. Eight patients are alive with no evidence of disease, with median follow-up of 20 months.
In our experience, the video-toracoscopic approach is a viable and safe option for the treatment of early stage esophageal cancer. Low incidence of complications and local recurrence should encourage a most frequent use of this procedure.
近期食管手术已采用微创方法进行改良。本文描述了作者在早期食管癌患者中应用胸腔镜技术行食管切除术的个人经验。
1996年至2000年期间，罗马“La Sapienza”大学胸外科为10例患者（7例男性，3例女性）实施了电视胸腔镜食管癌切除术。患者中位年龄为64岁（范围53 - 72岁）。患者取左侧卧位，在第4和第8肋间置入4个端口。游离胸段食管全长及周围结缔组织和食管旁淋巴结。随后行颈部切口，再经正中剖腹术将胃制成管状。
无人需要中转开胸。未观察到并发症或术中死亡。中位胸腔手术时间为110分钟（范围55 - 165分钟）。出院后30天内无死亡记录。1例患者出现左侧声带麻痹。1例患者术后2个月观察到颈部吻合口复发。1例患者术后36个月因转移扩散死亡。8例患者存活且无疾病证据，中位随访时间为20个月。
根据我们的经验，电视胸腔镜手术是治疗早期食管癌的一种可行且安全的选择。并发症和局部复发发生率低应促使更频繁地使用该手术方法。
