Division of Cardiothoracic Surgery, Columbia University Medical Center, 161 Fort Washington Avenue, Herbert Irving Pavilion, Suite 301, New York, NY 10032, USA.
J Thorac Cardiovasc Surg. 2012 May;143(5):1125-9. doi: 10.1016/j.jtcvs.2012.01.071.
Uncertainty exists among surgeons as to whether minimally invasive esophagectomy (MIE) is a comparable operation to open esophagectomy (OE). The surgical technique and oncologic dissection should not be degraded when using a minimally invasive approach.
We reviewed a single hospital's experience with both OE and MIE. From 2000 to 2010, 257 patients underwent esophagectomy by 1 of 3 surgical techniques: transhiatal, Ivor Lewis, or 3-hole.
Of the 257 patients (median age, 67 years; range, 58-74), 92 underwent MIE. Both groups were comparable in terms of gender, age, comorbidities, surgical technique, and induction chemotherapy and radiotherapy. The overall median follow-up was 29.5 months (range, 9.9-61.5). The MIE group had a significantly shorter operative time (MIE vs OE, 330 vs 365 minutes, P = .04), length of stay (MIE vs OE, 9 vs 12 days, P < .01), intensive care unit admission rate (MIE vs OE, 55% vs 81%, P < .01), intensive care unit length of stay (MIE vs OE, 1 vs 2 days, P < .01), and estimated blood loss (MIE vs OE, 100 vs 400 mL, P < .01). More lymph nodes were harvested in the MIE group than in the OE group (17 vs 11 nodes, P < .01). There were insignificant differences in 30-day mortality (MIE vs OE, 2.2% vs 3.0%; P = .93) and overall survival (P = .19), as well as in the rates of all complications, except pneumonia (MIE vs OE, 2% vs 13%; P = .01).
A thoracic surgeon can safely tailor the MIE to a patient's anatomy and oncologic demands while maintaining equivalent survival.
外科医生对于微创食管切除术（MIE）是否与开放食管切除术（OE）相当存在不确定性。采用微创方法时，不应降低手术技术和肿瘤解剖质量。
我们回顾了一家医院同时开展 OE 和 MIE 的经验。2000 年至 2010 年，有 257 例患者接受了以下 3 种手术技术之一的食管切除术：经胸、Ivor Lewis 或 3 孔。
257 例患者（中位年龄 67 岁；范围 58-74 岁）中，92 例行 MIE。两组在性别、年龄、合并症、手术技术以及诱导化疗和放疗方面具有可比性。总的中位随访时间为 29.5 个月（范围 9.9-61.5）。MIE 组的手术时间明显缩短（MIE 与 OE 相比，330 分钟与 365 分钟，P =.04），住院时间缩短（MIE 与 OE 相比，9 天与 12 天，P <.01），重症监护病房入院率降低（MIE 与 OE 相比，55%与 81%，P <.01），重症监护病房住院时间缩短（MIE 与 OE 相比，1 天与 2 天，P <.01），估计出血量减少（MIE 与 OE 相比，100 毫升与 400 毫升，P <.01）。MIE 组比 OE 组采集的淋巴结更多（17 个与 11 个淋巴结，P <.01）。30 天死亡率（MIE 与 OE 相比，2.2%与 3.0%；P =.93）和总生存率（P =.19）差异无统计学意义，除肺炎（MIE 与 OE 相比，2%与 13%；P =.01）外，所有并发症的发生率差异也无统计学意义。
胸外科医生可以根据患者的解剖结构和肿瘤需求安全地调整 MIE，同时保持等效的生存。
