Palanivelu Chinnusamy, Prakash Anand, Senthilkumar Rangaswamy, Senthilnathan Palanisamy, Parthasarathi Ramakrishnan, Rajan Pidigu Seshiyer, Venkatachlam S
Department of Minimal Access Surgery, GEM Hospital, Coimbatore, India.
J Am Coll Surg. 2006 Jul;203(1):7-16. doi: 10.1016/j.jamcollsurg.2006.03.016.
To evaluate outcomes after minimally invasive or thoracolaparoscopic esophagectomy (TLE) with thoracoscopic mobilization of the esophagus and mediastinal esophagectomy in prone position. Esophagectomies are being performed increasingly by a minimally invasive route with decreased morbidity and shorter hospital stay compared with conventional esophagectomy. Most series report thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in the left lateral position with respiratory complications up to 8% and prolonged operative time, probably because of inadequate stance of the surgeon during the thoracoscopic part. This study shows the potential of the thoracoscopic part of the procedure in prone position to ease these difficulties.
From January 1997 through April 2005, TLE was performed in 130 patients. All patients had histologically proved squamous cell carcinoma of the middle third of the esophagus. Only one (0.77%) patient received neoadjuvant chemotherapy. The thoracoscopic part of the procedure was performed in prone position with excellent ergonomics, translating into less operative time and better respiratory results. We performed a minilaparotomy to retrieve the specimen owing to bulky tumors. Feeding jejunostomy and pyloromyotomy were performed in all patients.
There were 102 men and 28 women. Median age was 67.5 years (range 38 to 78 years). There was no conversion to open method. Median ICU stay was 1 day (range 1 to 32 days) and median hospital stay was 8 days (range 4 to 68 days). Perioperative mortality was 1.54% (n = 2). Anastomotic leak rate was 2.31% (n = 3). There was no incidence of tracheal or lung injury and a very low incidence of postoperative pneumonia. At mean followup of 20 months (range 2 to 70 months), stage-specific survival was similar to open and other minimally invasive series.
TLE with thoracoscopic part in prone position is technically feasible, with a low incidence of respiratory complications and less operative time required. It provides comparable outcomes with other techniques of minimally invasive esophagectomy and most open series. In our experience, we observed a low mortality rate (1.54%), hospital stay of 8 days, and low incidence of postoperative pneumonia. It has the potential to replace conventional and other techniques of minimally invasive esophagectomy.
评估在俯卧位进行胸腔镜游离食管及纵隔食管切除术的微创或胸腹联合腹腔镜食管切除术（TLE）后的结果。与传统食管切除术相比，越来越多的食管切除术通过微创途径进行，其发病率降低且住院时间缩短。大多数系列报道在左侧卧位进行胸腔镜游离食管及纵隔淋巴结清扫术，呼吸并发症发生率高达8%且手术时间延长，这可能是因为在胸腔镜操作部分外科医生的体位不佳。本研究显示了在俯卧位进行该手术的胸腔镜部分以缓解这些困难的潜力。
从1997年1月至2005年4月，对130例患者进行了TLE。所有患者经组织学证实为食管中三分之一段的鳞状细胞癌。仅1例（0.77%）患者接受了新辅助化疗。手术的胸腔镜部分在俯卧位进行，人体工程学效果极佳，从而缩短了手术时间并改善了呼吸结果。由于肿瘤体积较大，我们进行了小切口剖腹术以取出标本。所有患者均进行了空肠造口喂养和幽门肌切开术。
男性102例，女性28例。中位年龄为67.5岁（范围38至78岁）。无中转开腹手术。中位重症监护病房停留时间为1天（范围1至32天），中位住院时间为8天（范围4至68天）。围手术期死亡率为1.54%（n = 2）。吻合口漏发生率为2.31%（n = 3）。无气管或肺损伤发生，术后肺炎发生率极低。平均随访20个月（范围2至70个月），特定分期生存率与开放手术及其他微创系列相似。
俯卧位胸腔镜部分的TLE在技术上是可行的，呼吸并发症发生率低且所需手术时间较短。它与其他微创食管切除术技术及大多数开放手术系列的结果相当。根据我们的经验，我们观察到死亡率低（1.54%）、住院时间为8天且术后肺炎发生率低。它有潜力取代传统及其他微创食管切除术技术。
