Xie Xuan, Fu Jian-hua, Wang Jun-ye, Zhang Xu, Luo Kong-jia, Yang Fu, Amos Ela Bella, Li Xiao-hai
Department of Thoracic Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2012 Sep;15(9):918-21.
To evaluate the learning process of video-assisted minimally invasive esophagectomy (MIE).
One hundred consecutive patients with thoracic esophageal carcinoma were treated by a same team of surgeons, and were divided into 3 groups in chronological order. The former two groups both consisted of 25 patients with thoracoscopy plus laparotomy. The remaining 50 patients were enrolled in the third group with thoracoscopy plus laparoscopy. Clinicopathological data including operative time, blood loss, protection of normal structures, complications, length of ICU stay, postoperative stay, and lymph nodes harvest, were collected and compared between groups.
Procedures were accomplished successfully in 96 patients. Only 4 cases were converted to open thoracotomy and none to laparotomy. The median operative time was 310 min and blood loss was 200 ml. The median number of lymph node harvest was 22. The overall complication rate was 50%. Comparison of first two groups revealed that significant differences existed in the preservation rate of arch of azygos vein (P=0.010), bronchial vessels (P=0.038), and exposure rate of thoracic part of left recurrent laryngeal nerve( P=0.048). Comparison of the former and latter 50 patients revealed that significant differences existed in thoracic operative time (P<0.001), blood loss (P=0.025), preservation rate of arch of azygos vein (P=0.001) and bronchial vessels (P<0.001), the number of lymph node harvest in thoracoscopy (P=0.022) and in left recurrent laryngeal nerve chain (P<0.001), and exposure rate of initiate part of left recurrent laryngeal nerve (P=0.002).
The learning curve of MIE is long and beginners should proceed step by step.
评估电视辅助微创食管切除术（MIE）的学习过程。
100例连续性胸段食管癌患者由同一手术团队治疗，并按时间顺序分为3组。前两组各有25例患者接受胸腔镜联合开腹手术。其余50例患者纳入第三组，接受胸腔镜联合腹腔镜手术。收集并比较各组的临床病理数据，包括手术时间、失血量、正常结构保护情况、并发症、重症监护病房（ICU）住院时间、术后住院时间及淋巴结清扫数量。
96例患者手术成功完成。仅4例中转开胸，无中转开腹病例。中位手术时间为310分钟，失血量为200毫升。中位淋巴结清扫数量为22枚。总体并发症发生率为50%。前两组比较显示奇静脉弓保留率（P = 0.010）、支气管血管保留率（P = 0.038）及左喉返神经胸段暴露率（P = 0.048）存在显著差异。前50例与后50例患者比较显示胸腔手术时间（P < 0.001）、失血量（P = 0.025）、奇静脉弓保留率（P = 0.001）及支气管血管保留率（P < 0.001）、胸腔镜下淋巴结清扫数量（P = 0.022）及左喉返神经链淋巴结清扫数量（P < 0.001）、左喉返神经起始部暴露率（P = 0.002）存在显著差异。
MIE的学习曲线较长，初学者应循序渐进。
