Kubo Naoshi, Ohira Masaichi, Yamashita Yoshito, Sakurai Katsunobu, Toyokawa Takahiro, Tanaka Hiroaki, Muguruma Kazuya, Shibutani Masatsune, Yamazoe Sadaaki, Kimura Kenjiro, Nagahara Hisashi, Amano Ryosuke, Ohtani Hiroshi, Yashiro Masakazu, Maeda Kiyoshi, Hirakawa Kosei
Department of Surgical Oncology, Graduate School of Medicine, Osaka City University 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan.
Anticancer Res. 2014 May;34(5):2399-404.
Pulmonary complications (PCs) after esophagectomy for patients with esophageal cancer have been correlated with prolonged hospital stays and in-hospital mortality. Previous studies have shown that minimally-invasive esophagectomy (MIE) is associated with a lower rate of PCs compared to conventional open surgery. Although PCs were reportedly associated with many factors, including surgical approaches, patients' demographics, and perioperative variables, the predictive factors for PCs including MIE, have not been fully evaluated.
A total of 209 patients with resectable esophageal cancer who underwent three types of esophagectomy were included in the present study; (i) 93 cases who underwent the combined thoracoscopic MIE and laparoscopic MIE; (ii) 42 cases who underwent the combined open thoracotomy and laparoscopic MIE; (iii) 74 cases who underwent the combined open thoracotomy and open laparotomy, which were defined as the total MIE group, hybrid MIE group, and total open group, respectively. We compared clinical outcomes of the three groups and identified postoperative predictive factors of PCs using multivariate analysis.
The incidence of PCs was significantly reduced (p=0.015) in the total-MIE group (8/93: 8.5%) compared with the total-open group (16/74: 21.6%), but it was not significantly reduced in the hybrid MIE group (5/42: 11.9%) compared with the total open group (p=0.19). The multivariate analysis showed that the presence of cardiac comorbidity [odds ratio (OR)=5.90; p=0.013], lung comorbidity (OR=3.95; p=0.031), and anastomotic leakage (OR=6.00; p<0.01) were independent risk factors for PCs after esophagectomy. In contrast, total MIE reduced the risk of PCs (OR=0.328; p=0.036).
The combination of thoracoscopic and laparoscopic MIE presents as an excellent surgical procedure for the reduction of PCs after esophagectomy.
食管癌患者行食管切除术后的肺部并发症（PCs）与住院时间延长和院内死亡率相关。既往研究表明，与传统开放手术相比，微创食管切除术（MIE）的PCs发生率较低。尽管据报道PCs与许多因素有关，包括手术方式、患者人口统计学特征和围手术期变量，但包括MIE在内的PCs预测因素尚未得到充分评估。
本研究共纳入209例可切除食管癌患者，他们接受了三种类型的食管切除术；（i）93例接受胸腔镜MIE和腹腔镜MIE联合手术；（ii）42例接受开胸手术和腹腔镜MIE联合手术；（iii）74例接受开胸手术和开腹手术联合手术，分别定义为全MIE组、混合MIE组和全开放组。我们比较了三组的临床结局，并通过多因素分析确定了PCs的术后预测因素。
与全开放组（16/74：21.6%）相比，全MIE组（8/93：8.5%）的PCs发生率显著降低（p=0.015），但与全开放组相比，混合MIE组（5/42：11.9%）的PCs发生率没有显著降低（p=0.19）。多因素分析显示，心脏合并症（比值比[OR]=5.90；p=0.013）、肺部合并症（OR=3.95；p=0.031）和吻合口漏（OR=6.00；p<0.01）是食管切除术后PCs的独立危险因素。相比之下，全MIE降低了PCs的风险（OR=0.328；p=0.036）。
胸腔镜和腹腔镜MIE联合手术是降低食管切除术后PCs的一种优秀手术方式。
