Berrisford R G, Wajed S A, Sanders D, Rucklidge M W M
Department of Thoracic and Upper Gastrointestinal Surgery, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK.
Br J Surg. 2008 May;95(5):602-10. doi: 10.1002/bjs.6054.
Minimally invasive oesophagectomy (MIO; thoracoscopy, laparoscopy, cervical anastomosis) is a complex procedure and few substantial series have been published. This study documented the morbidity, mortality and challenges of adopting MIO in a specialist unit in the UK.
A prospective group of 77 patients was listed consecutively with the intention of performing MIO. Three other patients underwent open oesophagectomy during the study period.
MIO was attempted in 77 patients, completed successfully in 70, abandoned in six patients (8 per cent) with unsuspected metastatic disease, and converted to a thoracoscopic anastomosis in one patient. There was one in-hospital death (1 per cent). Complications occurred in 33 patients (47 per cent), including nine gastric conduit-related complications (13 per cent). Median lymph node harvest was 21 (range 7-48) nodes. Mean overall and disease-free survival times were 35 and 33 months respectively. Median disease-free survival for patients with stage III disease was 26 months.
MIO can be performed with acceptable mortality and morbidity rates in an unselected series of patients. There was more morbidity related to gastric tube ischaemia than was expected.
微创食管切除术（MIO；胸腔镜、腹腔镜、颈部吻合术）是一种复杂的手术，仅有少量大型系列研究发表。本研究记录了在英国一家专科医院采用MIO的发病率、死亡率及面临的挑战。
前瞻性连续纳入77例计划行MIO的患者。研究期间另有3例患者接受了开放食管切除术。
77例患者尝试行MIO，70例成功完成，6例（8%）因意外发现转移性疾病而放弃手术，1例改为胸腔镜吻合术。有1例住院死亡（1%）。33例患者（47%）发生并发症，包括9例与胃管道相关的并发症（13%）。中位淋巴结清扫数为21枚（范围7 - 48枚）。平均总生存期和无病生存期分别为35个月和33个月。Ⅲ期疾病患者的中位无病生存期为26个月。
在未经选择的患者系列中，MIO可以在可接受的死亡率和发病率下进行。与胃管缺血相关的发病率高于预期。
