Luketich James D, Alvelo-Rivera Miguel, Buenaventura Percival O, Christie Neil A, McCaughan James S, Litle Virginia R, Schauer Philip R, Close John M, Fernando Hiran C
Division of Thoracic Surgery and Foregut Surgery, University of Pittsburgh Medical Center, Pittsburgh 15213, USA.
Ann Surg. 2003 Oct;238(4):486-94; discussion 494-5. doi: 10.1097/01.sla.0000089858.40725.68.
To assess our outcomes after minimally invasive esophagectomy (MIE).
Esophagectomy has traditionally been performed by open methods. Results from most series include mortality rates in excess of 5% and hospital stays frequently greater than 10 days. MIE has the potential to improve these results, but only a few small series have been reported. This report summarizes our experience of 222 cases.
From 1996 to 2002, MIE was performed in 222 patients. Indications for operation included high-grade dysplasia (n = 47) and cancer (n = 175). Neoadjuvant chemotherapy was used in 78 (35.1%) and radiation in 36 (16.2%). Initially, a laparoscopic transhiatal approach was used (n = 8), but subsequently our approach evolved to include thoracoscopic mobilization (n = 214).
There were 186 men and 36 women. Median age was 66.5 years (range, 39-89). Nonemergent conversion to open procedure was required in 16 patients (7.2%). MIE was successfully completed in 206 (92.8%) patients. The median intensive care unit stay was 1 day (range, 1-30); hospital stay was 7 days (range, 3-75). Operative mortality was 1.4% (n = 3). Anastomotic leak rate was 11.7% (n = 26). At a mean follow-up of 19 months (range, 1-68), quality of life scores were similar to preoperative values and population norms. Stage specific survival was similar to open series.
MIE offers results as good as or better than open operation in our center with extensive minimally invasive and open experience. In this single institution experience, we observed a lower mortality rate (1.4%) and shorter hospital stay (7 days) than most open series. Given these results, we are now developing an intergroup trial (ECOG 2202) to assess MIE in a multicenter setting.
评估微创食管切除术（MIE）的治疗效果。
传统上食管切除术采用开放手术方式。大多数系列研究结果显示死亡率超过5%，住院时间常常超过10天。MIE有可能改善这些结果，但仅有少数小样本系列报道。本报告总结了我们222例患者的经验。
1996年至2002年期间，对222例患者实施了MIE。手术适应证包括高级别异型增生（n = 47）和癌症（n = 175）。78例（35.1%）患者接受了新辅助化疗，36例（16.2%）接受了放疗。最初采用腹腔镜经裂孔入路（n = 8），但随后我们的手术方式演变为包括胸腔镜游离术（n = 214）。
男性186例，女性36例。中位年龄为66.5岁（范围39 - 89岁）。16例患者（7.2%）需要非急诊转为开放手术。206例（92.8%）患者成功完成MIE。重症监护病房中位住院时间为1天（范围1 - 30天）；住院时间为7天（范围3 - 75天）。手术死亡率为1.4%（n = 3）。吻合口漏发生率为11.7%（n = 26）。平均随访19个月（范围1 - 68个月），生活质量评分与术前值及人群标准相似。特定分期生存率与开放手术系列相似。
在我们中心，MIE的治疗效果与开放手术相当或更好，我们拥有丰富的微创和开放手术经验。在这一单一机构经验中，我们观察到死亡率（1.4%）低于大多数开放手术系列，住院时间（7天）也更短。鉴于这些结果，我们目前正在开展一项多组间试验（ECOG 2202），以在多中心环境中评估MIE。
