Peyre Christian G, DeMeester Steven R, Rizzetto Christian, Bansal Neeraj, Tang Andrew L, Ayazi Shahin, Leers Jessica M, Lipham John C, Hagen Jeffrey A, DeMeester Tom R
Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
Ann Surg. 2007 Oct;246(4):665-71; discussion 671-4. doi: 10.1097/SLA.0b013e318155a7a1.
Our aim was to compare outcome of vagal-sparing esophagectomy with transhiatal and en bloc esophagectomy in patients with intramucosal adenocarcinoma or high-grade dysplasia.
Intramucosal adenocarcinoma and high grade dysplasia have a low likelihood of lymphatic or systemic metastases and esophagectomy is curative in most patients. However, traditional esophagectomy is associated with significant morbidity and altered gastrointestinal function. A vagal-sparing esophagectomy offers the advantages of complete disease removal with the potential for reduced morbidity and a better functional outcome.
Retrospective review of outcome in patients with intramucosal adenocarcinoma or high grade dysplasia that had a vagal-sparing (n=49), transhiatal (n=39) or en bloc (n=21) esophagectomy.
The length of hospital stay and the incidence of major complications was significantly reduced with a vagal-sparing esophagectomy compared with a transhiatal or en bloc resection. Further, postvagotomy dumping and diarrhea symptoms were significantly less common, and weight was better maintained postoperatively with a vagal-sparing esophagectomy. Recurrent cancer has developed in only 1 patient.
Survival with intramucosal adenocarcinoma or Barrett's with high-grade dysplasia is independent of the type of resection. A vagal-sparing esophagectomy is associated with significantly less perioperative morbidity and a shorter hospital stay than a transhiatal or en bloc esophagectomy. Further, late morbidity including weight loss, dumping, and diarrhea are significantly less likely after a vagal-sparing approach. Consequently a vagal-sparing esophagectomy is the preferred procedure for patients with intramucosal adenocarcinoma or high grade dysplasia.
我们的目的是比较保留迷走神经的食管切除术与经裂孔食管切除术和整块食管切除术治疗黏膜内腺癌或高级别异型增生患者的疗效。
黏膜内腺癌和高级别异型增生发生淋巴或全身转移的可能性较低，大多数患者行食管切除术可治愈。然而，传统的食管切除术会导致显著的发病率和胃肠道功能改变。保留迷走神经的食管切除术具有完全切除病变的优势，且有可能降低发病率并获得更好的功能结局。
回顾性分析接受保留迷走神经（n = 49）、经裂孔（n = 39）或整块（n = 21）食管切除术的黏膜内腺癌或高级别异型增生患者的疗效。
与经裂孔或整块切除术相比，保留迷走神经的食管切除术显著缩短了住院时间并降低了主要并发症的发生率。此外，可以显著减少迷走神经切断术后倾倒综合征和腹泻症状的发生，并且保留迷走神经的食管切除术患者术后体重维持得更好。仅1例患者出现复发癌。
黏膜内腺癌或伴有高级别异型增生的巴雷特食管患者的生存率与切除类型无关。与经裂孔或整块食管切除术相比，保留迷走神经的食管切除术围手术期发病率显著更低，住院时间更短。此外，保留迷走神经手术术后出现体重减轻、倾倒综合征和腹泻等晚期发病率显著更低。因此，保留迷走神经的食管切除术是黏膜内腺癌或高级别异型增生患者的首选术式。
