Cash J Christian, Zehetner Joerg, Hedayati Bobak, Bildzukewicz Nikolai A, Katkhouda Namir, Mason Rodney J, Lipham John C
Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St, Suite 514, Los Angeles, CA, 90033, USA.
Surg Endosc. 2014 Feb;28(2):492-9. doi: 10.1007/s00464-013-3230-y. Epub 2013 Oct 8.
Most published minimally invasive esophagectomy techniques involve a multiple field approach, including laparoscopic and thoracoscopic esophageal mobilization. Laparoscopic transhiatal esophagectomy (LTE) should potentially reduce the complications associated with thoracotomy. This study aims to compare outcomes of LTE with open transhiatal esophagectomy (OTE) and en-bloc esophagectomy (EBE).
Retrospective chart review was performed on all patients who had an LTE for cancer between July 2008 and July 2012 at our institution. Data was compared with an historic cohort of patients who underwent OTE and EBE at the same institution from July 2002 to July 2008.
There were 33 patients with LTE, compared with 60 patients with OTE and 139 with EBE. The presence of minor operative complications was similar (p = 0.36), but major complications were significantly less common in the LTE group (12, 23 and 33 %, respectively; p = 0.04). The median number of blood transfusions during hospitalization was significantly lower in the LTE group (0, 2.5 and 3, respectively; p = 0.005). Median tumor size was significantly smaller (1.5, 2.2, and 3 cm, respectively; p = 0.03), but the LTE group had a significantly higher percentage of patients with neoadjuvant treatment (39, 14 and 29 %, respectively; p = 0.008). Median lymph node yield for LTE was lower (24, 36 and 48, respectively; p < 0.0001), but the percentage of patients with positive nodes was similar (33, 33 and 39 %, respectively; p = 0.69). Mortality was equivalent among the groups (0, 2 and 4 %, respectively; p = 0.38). The median LOS for the LTE group was significantly lower (10, 13 and 15 days, respectively; p < 0.0001). Overall survival was not different between the three groups (p = 0.65), with median survival at 24 months of 70, 65 and 65 %, respectively.
LTE can be performed safely with less major complications and shorter hospital stay than open esophagectomy. The reduced lymph-node harvest did not impact overall survival.
大多数已发表的微创食管切除术技术都涉及多区域方法，包括腹腔镜和胸腔镜下食管游离。腹腔镜经裂孔食管切除术（LTE）可能会减少与开胸手术相关的并发症。本研究旨在比较LTE与开放经裂孔食管切除术（OTE）和整块食管切除术（EBE）的疗效。
对2008年7月至2012年7月在我院接受LTE治疗癌症的所有患者进行回顾性病历审查。将数据与2002年7月至2008年在同一机构接受OTE和EBE的历史队列患者进行比较。
有33例患者接受LTE，60例接受OTE，139例接受EBE。轻微手术并发症的发生率相似（p = 0.36），但LTE组的严重并发症明显较少见（分别为12%、23%和33%；p = 0.04）。LTE组住院期间的中位输血量明显更低（分别为0、2.5和3；p = 0.005）。中位肿瘤大小明显更小（分别为1.5、2.2和3 cm；p = 0.03），但LTE组接受新辅助治疗的患者比例明显更高（分别为39%、14%和29%；p = 0.008）。LTE的中位淋巴结收获数更低（分别为24、36和48；p < 0.0001），但淋巴结阳性患者的比例相似（分别为33%、33%和39%；p = 0.69）。各组的死亡率相当（分别为0%、2%和4%；p = 0.38）。LTE组的中位住院时间明显更短（分别为10、13和15天；p < 0.0001）。三组的总生存率无差异（p = 0.65），24个月时的中位生存率分别为70%、65%和65%。
与开放食管切除术相比，LTE可以安全地进行，严重并发症更少，住院时间更短。淋巴结收获减少并未影响总生存率。
