Department of Surgery, Mayo Clinic-Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
Surg Endosc. 2013 Feb;27(2):553-7. doi: 10.1007/s00464-012-2479-x. Epub 2012 Aug 31.
Minimally invasive esophagectomy (MIE) is performed through various approaches, including using video-assisted thoracoscopic surgery for mediastinal esophageal dissection. The prone technique allows for gravity-aided retraction of the lung. The aim of this study was to examine perioperative outcomes after prone MIE in relation to patient preoperative comorbidities.
A retrospective cohort study from our single tertiary-care center is presented. Between January 2007 and August 2010, a total of 42 patients underwent three-field prone MIE. The majority of patients were male (37 vs. 5 female), with an average age of 68 years (range = 37-87). The diagnoses for patients who underwent MIE were 35 adenocarcinoma, four Barrett's esophagus with high-grade dysplasia, two achalasia, and one squamous cell carcinoma. Neoadjuvant chemotherapy with or without radiotherapy was administered to 16 (38 %) patients. Preoperative comorbidities were quantified using the Modified Charlson Comorbidity Index; low risk was defined as a score of 0-2 (23 patients), moderate risk 3-4 (14 patients), and high risk 5 or higher (five patients). Postoperative complications were stratified using the Clavien Classification Scale; minor complications were grades 1 and 2 and major complications were grades 3-5.
Median length of hospital stay was 8 days (range = 6-51) and median ICU stay was 2 days (range = 1-26). Average prone surgical time was 108 min (range = 67-198). Thirty-seven of 42 patients (88 %) were extubated on the day of operation. Postoperatively, all five high-risk patients had a complication, three of which were major. Eight of the 14 moderate-risk patients had a complication and three were major, and 17 of the 23 low-risk group had a complication with nine being major. There was a total of 15 major complications. Predominant complications were arrhythmias (15) and pneumonia (five), with four anastomotic leaks and two postoperative 30-day mortalities.
This series supports using prone MIE. Despite a clinical pathway, including immediate extubation postoperatively, there is still a risk of pulmonary complications that appears to correlate with higher preoperative comorbidity scores.
微创食管切除术（MIE）通过多种途径进行，包括使用电视辅助胸腔镜手术进行纵隔食管解剖。俯卧位技术允许肺部在重力作用下被牵拉。本研究的目的是检查俯卧位 MIE 术后与患者术前合并症相关的围手术期结果。
呈现了一项来自我们单一三级护理中心的回顾性队列研究。2007 年 1 月至 2010 年 8 月，共有 42 例患者接受了三野俯卧位 MIE。大多数患者为男性（37 例 vs. 5 例女性），平均年龄为 68 岁（范围=37-87 岁）。接受 MIE 的患者的诊断为 35 例腺癌、4 例 Barrett 食管伴高级别异型增生、2 例贲门失弛缓症和 1 例鳞状细胞癌。16 例（38%）患者接受了新辅助化疗加或不加放疗。使用改良 Charlson 合并症指数对术前合并症进行量化；低危定义为评分 0-2（23 例）、中危 3-4（14 例）和高危 5 或更高（5 例）。使用 Clavien 分类量表对术后并发症进行分层；轻度并发症为 1 级和 2 级，重度并发症为 3-5 级。
中位住院时间为 8 天（范围=6-51），中位 ICU 住院时间为 2 天（范围=1-26）。平均俯卧手术时间为 108 分钟（范围=67-198）。42 例患者中有 37 例（88%）在手术当天拔管。术后，所有 5 例高危患者均发生并发症，其中 3 例为重度并发症。14 例中危患者中有 8 例发生并发症，其中 3 例为重度并发症，23 例低危患者中有 17 例发生并发症，其中 9 例为重度并发症。共有 15 例重度并发症。主要并发症为心律失常（15 例）和肺炎（5 例），吻合口漏 4 例，术后 30 天死亡 2 例。
本系列研究支持使用俯卧位 MIE。尽管采用了临床途径，包括术后立即拔管，但仍存在肺部并发症的风险，这似乎与术前合并症评分较高有关。
