Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Surg Endosc. 2012 Feb;26(2):381-90. doi: 10.1007/s00464-011-1883-y. Epub 2011 Sep 5.
During esophagectomy, laparoscopy can be used together with thoracoscopy, but it is not known whether a combined thoracoscopic-laparoscopic procedure is associated with fewer postoperative complications than open esophagectomy, and without compromising oncological outcome.
This was a longitudinal cohort study that included 185 esophageal cancer patients, including 72 who underwent combined thoracoscopic-laparoscopic esophagectomy (TLE), 34 who underwent thoracoscopic esophagectomy (TE), and 79 who underwent open esophagectomy (OE) between January 2002 and May 2010. The main outcome measures were postoperative respiratory and overall complications. The secondary outcome was 2-year relapse-free survival (RFS).
Respiratory complications occurred in 9 patients who underwent TLE, 13 who underwent TE, and 31 who underwent OE. TLE was associated with fewer respiratory complications (TLE vs. OE: odds ratio [OR], 0.22; 95% confidence interval [CI], 0.09-0.53 and TE vs. OE: OR, 0.71; 95% CI 0.29-1.76). Overall complications occurred in 34 patients who underwent TLE, 20 who underwent TE, and 54 who underwent OE. TLE was associated with fewer overall complications (TLE vs. OE: OR, 0.47; 95% CI 0.23-0.94 and TE vs. OE: OR, 0.51; 95% CI 0.21-1.25). The 2-year RFS rates were similar among the three groups: 71.6% for TLE, 57.7% for TE, and 58.3% for OE (TLE vs. OE: hazard ratio, 0.65; 95% CI 0.35-1.20 and TE vs. OE: hazard ratio, 0.91; 95% CI 0.45-1.82).
Unlike TE, TLE was associated with fewer postoperative complications than was OE, with no compromise of 2-year RFS. A randomized controlled trial with longer follow-up is needed.
在食管癌手术中，腹腔镜可与胸腔镜联合使用，但尚不清楚胸腔镜联合腹腔镜手术是否比开放食管癌手术术后并发症更少，同时不影响肿瘤学结果。
这是一项回顾性队列研究，纳入了 185 例食管癌患者，其中 72 例行胸腔镜联合腹腔镜食管癌切除术（TLE），34 例行胸腔镜食管癌切除术（TE），79 例行开放食管癌切除术（OE），时间为 2002 年 1 月至 2010 年 5 月。主要观察指标为术后呼吸系统并发症和总体并发症。次要观察指标为 2 年无复发生存率（RFS）。
TLE 组 9 例、TE 组 13 例和 OE 组 31 例患者发生呼吸系统并发症。TLE 组呼吸系统并发症发生率较低（TLE 与 OE：比值比 [OR]，0.22；95%置信区间 [CI]，0.09-0.53；TE 与 OE：OR，0.71；95%CI 0.29-1.76）。TLE 组 34 例、TE 组 20 例和 OE 组 54 例患者发生总体并发症。TLE 组总体并发症发生率较低（TLE 与 OE：OR，0.47；95%CI 0.23-0.94；TE 与 OE：OR，0.51；95%CI 0.21-1.25）。三组 2 年 RFS 率相似：TLE 组为 71.6%，TE 组为 57.7%，OE 组为 58.3%（TLE 与 OE：风险比，0.65；95%CI 0.35-1.20；TE 与 OE：风险比，0.91；95%CI 0.45-1.82）。
与 TE 不同，TLE 术后并发症少于 OE，但 2 年 RFS 无差异。需要开展具有更长随访时间的随机对照试验。
