Mao Teng, Fang Wen-tao, Gu Zhi-tao, Yao Feng, Guo Xu-feng, Chen Wen-hu
Department of Thoracic Surgery, Shanghai Jiaotong University, Shanghai, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2012 Sep;15(9):922-5.
To analyze the differences in perioperative morbidity and lymph node dissection between minimally invasive esophageal carcinoma resection and open procedure.
From January to December 2011, 72 patients with esophageal cancer underwent surgery. Thirty-four patients underwent video-assisted esophagectomy, and 38 underwent open procedure. In the minimally invasive group, there were 7 thoraco-laparoscopic cases, 16 thoracoscopic cases, and 11 laparoscopic cases.
The early cases (T1-T2) were more common in the minimally invasive group than that in the open group [79.4%(27/34) vs. 55.3%(21/38), P<0.05]. The complication rate was 41.2%(11/34) in the open group and 42.1%(16/38) in the minimally invasive group, and the difference was not statistically significant (P>0.05). However, the functional complication in minimally invasive group was significantly lower than that in open group [2.9%(1/34) vs. 28.9%(11/38), P<0.01], while technical complications (anastomotic leak and recurrent laryngeal nerve injury) were significantly more common( 38.2% vs. 10.5%, P<0.05). Lymph node group number in minimally invasive group was comparable with the open group (9.1 vs. 11.2, P>0.05), but the number of node in minimally invasive group was significantly lower (13.5±5.9 vs. 17.8±5.2, P<0.05). When stratified by time period, early 17 cases were associated with similar technical complication rate with the late 17 cases (P>0.05), while thoracic lymph node group number, number of node, and positive node were improved in the late phase (all P>0.05).
Minimally invasive esophagectomy reduces functional morbidity, while technical complication including anastomotic leak and recurrent laryngeal nerve injury may be increased. Endoscopic lymph node dissection may be comparable to open surgery.
分析微创食管癌切除术与开放手术在围手术期发病率及淋巴结清扫方面的差异。
2011年1月至12月，72例食管癌患者接受手术治疗。34例行电视辅助食管切除术，38例行开放手术。微创组中，有7例胸腹腔镜联合手术、16例胸腔镜手术及11例腹腔镜手术。
微创组早期病例（T1-T2）比开放组更常见[79.4%（27/34）对55.3%（21/38），P<0.05]。开放组并发症发生率为41.2%（11/34），微创组为42.1%（16/38），差异无统计学意义（P>0.05）。然而，微创组的功能并发症显著低于开放组[2.9%（1/34）对28.9%（11/38），P<0.01]，而技术并发症（吻合口漏和喉返神经损伤）明显更常见（38.2%对10.5%，P<0.05）。微创组的淋巴结组数与开放组相当（9.1对11.2，P>0.05），但微创组的淋巴结数量显著更低（13.5±5.9对17.8±5.2，P<0.05）。按时间段分层时，早期17例与晚期17例的技术并发症发生率相似（P>0.05），而晚期胸腔淋巴结组数、淋巴结数量及阳性淋巴结情况有所改善（均P>0.05）。
微创食管切除术可降低功能发病率，但包括吻合口漏和喉返神经损伤在内的技术并发症可能增加。内镜下淋巴结清扫可能与开放手术相当。
