Elorza-Orúe José L, Larburu-Etxaniz Santiago, Asensio-Gallego José Ignacio, Enríquez-Navascués José María, Echenique-Elizondo Miguel
Sección de Cirugía Esofagogástrica, Hospital Donostia, Donostia-San Sebastián, Guipúzcoa, España.
Cir Esp. 2006 Sep;80(3):151-6. doi: 10.1016/s0009-739x(06)70943-5.
Currently, the bases for the treatment of esophageal cancer are surgical resection and chemotherapy. Among the various surgical techniques used, minimally invasive esophagectomy (MIE) aims to reduce surgical aggression and cardiopulmonary complications while maintaining basic oncological principles. We present the results of our initial experience with this technique in the treatment of esophageal cancer.
Fourteen patients with a diagnosis of esophageal cancer were selected to undergo MIE in three stages: right thoracoscopy, laparoscopy, and left cervicotomy with cervical esophagogastric anastomosis. Histological diagnosis was epidermoid carcinoma (n = 11) and high grade dysplasia (n = 3), one of which was highly suspicious of malignant transformation. After extension studies, preoperative clinical stages were as follows: stage 0 (n = 3), stage IIA (n = 10), and stage III (n = 1). Seven patients were treated with chemotherapy and neoadjuvant radiotherapy and the remainder underwent surgery without prior treatment.
The mean operating time was 299 minutes (range: 195-425). The conversion rate was 14% (n = 2). Mortality was 0% and morbidity was 50%, consisting of three major complications and four minor complications. No anastomotic dehiscence or wound infections were observed. Complete (R0) resections were achieved in 92.8% (n = 13). Transfusion needs were 1.1 U/patient. The mean number of nodes removed was 10.2/patient (range: 5-17). The mean length of hospital stay was 21 days (range: 9-64). Postoperative follow-up ranged from 1 to 17 months. All patients were alive and disease-free except for one patient with liver metastases.
Although MIE is a demanding technique, we believe that it is technically feasible in the treatment of esophageal cancer with acceptable postoperative morbidity and mortality. Consequently, it should be considered as an alternative to open surgery in selected patients.
目前，食管癌的治疗基础是手术切除和化疗。在使用的各种手术技术中，微创食管切除术（MIE）旨在减少手术创伤和心肺并发症，同时维持基本的肿瘤学原则。我们展示了我们在食管癌治疗中首次使用该技术的经验结果。
选择14例诊断为食管癌的患者分三个阶段进行MIE：右胸镜检查、腹腔镜检查以及左颈部切开术并进行颈部食管胃吻合术。组织学诊断为表皮样癌（n = 11）和高级别异型增生（n = 3），其中1例高度怀疑恶变。经过进一步检查，术前临床分期如下：0期（n = 3），IIA期（n = 10），III期（n = 1）。7例患者接受了化疗和新辅助放疗，其余患者未接受术前治疗直接接受手术。
平均手术时间为299分钟（范围：195 - 425分钟）。中转率为14%（n = 2）。死亡率为0%，发病率为50%，包括3例主要并发症和4例次要并发症。未观察到吻合口裂开或伤口感染。92.8%（n = 13）的患者实现了根治性（R0）切除。每位患者的输血量为1.1单位。每位患者平均切除的淋巴结数量为10.2个（范围：5 - 17个）。平均住院时间为21天（范围：9 - 64天）。术后随访时间为1至17个月。除1例有肝转移的患者外，所有患者均存活且无疾病。
尽管MIE是一项要求较高的技术，但我们认为它在治疗食管癌方面技术上是可行的，术后发病率和死亡率可接受。因此，在选定的患者中应将其视为开放手术的替代方案。
