Department of Surgery, Creighton University Medical Center, Omaha, NE 68131, USA.
Surg Endosc. 2012 Jan;26(1):168-76. doi: 10.1007/s00464-011-1850-7. Epub 2011 Aug 19.
Reports on quality of life (QOL) after minimally invasive esophagectomy (MIE) have been limited. This report compares perioperative outcomes, survival, and QOL after MIEs with open transthoracic esophagectomy (TTE) and open transhiatal esophagectomy (THE).
After institutional review board approval, retrospective review of a prospectively maintained database identified patients who underwent esophageal resection for esophageal cancer at Creighton University between August 2003 and August 2010. Patients with preoperative stage 4 disease, emergent procedures, laparoscopic transhiatal esophagectomies, or esophagojeujunostomies were excluded from the study. The study patients were categorized as having undergone open TTE, open THE, or MIE. Overall survival (OS) was the interval between diagnosis and death or follow-up assessment. Disease-free survival (DFS) was the interval between surgery and recurrence, death, or follow-up assessment. For the patients who survived at least 1 year after surgery, QOL was assessed using European Organization for Research and Treatment of Cancer (EORTC-QLQ, version 3.0) and esophageal module (EORTC-QLQ OES 18) questionnaires.
The study criteria were satisfied by 104 patients. Lymph node harvest with MIE (median = 20) was similar to that with open TTEs (median = 19) and significantly higher (P < 0.001) than that with open THEs (median = 12). The percentage of patients requiring intraoperative blood transfusion in the MIE group (23.4%) was significantly lower (P < 0.001) than in the open TTE (73.1%) and THE (67.7%) groups. The volume of intraoperative blood product transfusion was significantly lower for the MIE patients (median = 0 ml) than for the open TTE (median = 700 ml) and THE (median = 700 ml) patients. The incidence of respiratory complications with MIEs (10.64%) was significantly lower than with open TTEs (34.61%) and THEs (32.26%). The groups did not differ significantly in terms of R0 resection rates, OS, DFS, or QOL.
MIEs offer a safe and viable alternative to open esophagectomies because they reduce the need and volume of intraoperative blood product transfusion and postoperative respiratory complications without compromising oncological clearance, survival, and QOL.
微创食管切除术（MIE）后的生活质量（QOL）报告有限。本报告比较了 MIE 与开胸经胸食管切除术（TTE）和开胸经食管裂孔食管切除术（THE）的围手术期结果、生存率和 QOL。
在机构审查委员会批准后，回顾性分析了 2003 年 8 月至 2010 年 8 月期间在克赖顿大学接受食管癌食管切除术的患者的前瞻性维护数据库。排除了术前第 4 期疾病、急诊手术、腹腔镜经食管裂孔食管切除术或食管胃吻合术的患者。研究患者分为 TTE 开放组、THE 开放组和 MIE 组。总生存（OS）是从诊断到死亡或随访评估的时间间隔。无病生存（DFS）是从手术到复发、死亡或随访评估的时间间隔。对于至少在手术后 1 年存活的患者，使用欧洲癌症研究与治疗组织（EORTC-QLQ，版本 3.0）和食管模块（EORTC-QLQ OES 18）问卷评估 QOL。
104 例患者符合研究标准。MIE 组的淋巴结采集（中位数=20）与开放 TTE 组（中位数=19）相似，明显高于开放 THE 组（中位数=12）（P<0.001）。MIE 组需要术中输血的患者比例（23.4%）明显低于开放 TTE 组（73.1%）和 THE 组（67.7%）（P<0.001）。MIE 患者术中血制品输注量明显低于开放 TTE（中位数=0ml）和 THE（中位数=700ml）患者（中位数=700ml）（P<0.001）。MIE 患者（10.64%）的呼吸并发症发生率明显低于开放 TTE（34.61%）和 THE（32.26%）（P<0.001）。各组在 R0 切除率、OS、DFS 或 QOL 方面无显著差异。
MIE 为开胸食管切除术提供了一种安全可行的替代方法，因为它减少了术中血液制品的需求和输注量，并减少了术后呼吸并发症，而不会影响肿瘤清除率、生存率和 QOL。
