Osugi H, Takemura M, Higashino M, Takada N, Lee S, Ueno M, Tanaka Y, Fukuhara K, Hashimoto Y, Fujiwara Y, Kinoshita H
Department of Gastroenterological Surgery, Osaka City University Medical School.
Surg Endosc. 2002 Nov;16(11):1588-93. doi: 10.1007/s00464-002-9019-z. Epub 2002 Jun 27.
The efficacy of thoracoscopic radical esophagectomy for cancer has yet to be established, mainly because previous reports have not included a sufficient number of cases.
Seventy-five treatment-naive patients with esophageal cancer without contiguous spread underwent esophageal mobilization and extensive mediastinal lymphadenectomy through a 5-cm mini-thoracotomy and four trocar ports.
Video-assisted thoracoscopic surgery was performed without major intraoperative complications or emergency conversion to open surgery. We retrieved 34.1+/-13.0 mediastinal nodes, including 11.5+/-3.8 tracheobronchial nodes and 6.2+/-3.0 recurrent laryngeal nodes. Mean time of operation and blood loss were less in the last 39 patients than the first 36 (186.7+/-25.3 min and 165.4+/-101.8 g vs 270. 2+/-96.0 min and 421.5+/-31.2 g, respectively: p <0.0001 and p <0.001). Pulmonary morbidity was 5% in the later 39 patients. Survival was 90%, 80%, and 57% at 1, 2, and 5 years after surgery.
Thoracoscopic radical esophagectomy has less morbidity and comparable survival to conventional surgery, after a moderate amount of experience. Mini-thoracotomy is essential to perform the procedure safely and effectively.
电视胸腔镜根治性食管癌切除术的疗效尚未确定，主要原因是既往报告的病例数量不足。
75例未经治疗的无相邻扩散的食管癌患者通过5cm的小切口开胸术和4个套管针端口进行食管游离和广泛的纵隔淋巴结清扫术。
电视辅助胸腔镜手术未出现重大术中并发症，也未紧急转为开放手术。我们共获取34.1±13.0枚纵隔淋巴结，其中包括11.5±3.8枚气管支气管淋巴结和6.2±3.0枚喉返神经淋巴结。后39例患者的平均手术时间和失血量均少于前36例（分别为186.7±25.3分钟和165.4±101.8克，对比270.2±96.0分钟和421.5±312.克：p<0.0001和p<0.001）。后39例患者的肺部并发症发生率为5%。术后1年、2年和5年的生存率分别为90%、80%和57%。
经过一定量经验积累后，电视胸腔镜根治性食管癌切除术的并发症较少，生存率与传统手术相当。小切口开胸术对于安全有效地实施该手术至关重要。
