Departments of Digestive and Oncological Surgery, University Hospital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, France.
Br J Surg. 2012 Nov;99(11):1547-53. doi: 10.1002/bjs.8931.
Morbidity after oesophageal cancer surgery remains high, mainly due to major postoperative pulmonary complications (MPPCs). The aim of this study was to test the hypothesis that hybrid minimally invasive oesophagectomy (HMIO) decreases the 30-day MPPC rate without compromising oncological outcomes.
Consecutive patients undergoing curative oesophagectomy for cancer by laparoscopic gastric mobilization and open thoracotomy (HMIO) between January 2004 and December 2009 were matched to randomly selected patients undergoing a totally open approach during the same study interval. Matching variables were age, sex, cancer stage, location of the primary tumour, histological subtype, American Society of Anesthesiologists grade, malnutrition, neoadjuvant chemoradiation and epidural analgesia.
MPPCs at 30 days were significantly less frequent after HMIO compared with open surgery (15·7 versus 42·9 per cent; P < 0·001). Postoperative in-hospital mortality and overall morbidity rates were 4·3 and 47·5 per cent respectively, again significantly lower in the HMIO group: 1·4 versus 7·1 per cent (P = 0·018) and 35·7 versus 59·3 per cent (P < 0·001). In multivariable analysis, HMIO, adenocarcinoma subtype, epidural analgesia and surgery after 2006 were independent protective factors against MPPCs, and HMIO was independently protective against acute respiratory distress syndrome (ARDS). Lymph node yields and survival were similar in the two groups.
HMIO for oesophageal cancer, using laparoscopic gastric mobilization and open right thoracotomy, offered a substantial and independent protective effect against MPPCs, including ARDS, without compromising oncological outcomes.
食管癌手术后的发病率仍然很高，主要是由于术后发生重大肺部并发症（MPPC）。本研究旨在验证假设，即混合微创食管切除术（HMIO）可降低 30 天 MPPC 发生率，而不影响肿瘤学结果。
连续纳入 2004 年 1 月至 2009 年 12 月期间接受腹腔镜胃动员和开胸手术（HMIO）根治性食管癌切除术的患者，并与同期随机选择接受完全开放手术的患者进行匹配。匹配变量包括年龄、性别、癌症分期、原发肿瘤位置、组织学亚型、美国麻醉医师协会分级、营养不良、新辅助放化疗和硬膜外镇痛。
HMIO 后 30 天 MPPC 发生率明显低于开放手术（15.7%比 42.9%；P<0.001）。术后院内死亡率和总发病率分别为 4.3%和 47.5%，HMIO 组再次显著降低：1.4%比 7.1%（P=0.018）和 35.7%比 59.3%（P<0.001）。多变量分析显示，HMIO、腺癌亚型、硬膜外镇痛和 2006 年后手术是 MPPC 的独立保护因素，HMIO 是急性呼吸窘迫综合征（ARDS）的独立保护因素。两组淋巴结产量和生存情况相似。
HMIO 治疗食管癌，采用腹腔镜胃动员和开胸右路，可显著降低包括 ARDS 在内的 MPPC 发生率，而不影响肿瘤学结果。
