Li Jingpei, Shen Yaxing, Tan Lijie, Feng Mingxiang, Wang Hao, Xi Yong, Wang Qun
Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Surg Endosc. 2015 Apr;29(4):925-30. doi: 10.1007/s00464-014-3753-x. Epub 2014 Sep 24.
Open esophagectomy (OE) in elderly patients with esophageal cancer is hazardous due to high surgical mortality and limited survival. The aim of this study was to explore whether minimally invasive esophagectomy (MIE) has perioperative or long-term benefits in elderly patients with esophageal cancer compared with OE.
Between February 2005 and June 2013, 407 patients older than 70 years underwent esophagectomy for esophageal cancer, including 89 who received MIE and 318 who received OE. A retrospective pair-matched study was performed to compare 116 patients (58 pairs) who underwent either OE or MIE. Patients were matched by age, sex, comorbidity, tumor location, histology, TNM stage, and operative approach. Perioperative and long-term outcomes were compared between the two groups.
The overall incidence of postoperative complications was significantly lower in the MIE group than in the OE group (37.9 vs. 60.3 %, P = 0.016), especially incidence of pulmonary complications (20.7 vs. 39.7 %, P = 0.026). The mean length of hospital stay was also significantly shorter (10 days [range 7-70] vs. 12 days [range 8-106], P = 0.032). The perioperative mortality rate trended lower in the MIE group but was not significantly different (3.4 vs. 8.6 %, P = 0.435). Kaplan-Meier analysis showed that the median disease-specific survival time in the MIE group was significantly longer than in the OE group (>27 months [range 1-82] vs. 24 months [range 1-99], P = 0.003). No difference was found in overall survival (39 ± 8.9 vs. 22 ± 3.4 months, P = 0.070).
In surgical management of elderly patients with esophageal cancer, MIE is associated with lower rates of morbidity and pulmonary complications as well as longer disease-specific survival time. Whether it provides benefit to patients' long-term survival requires further research.
老年食管癌患者行开放食管切除术（OE）因手术死亡率高和生存受限而具有危险性。本研究的目的是探讨与开放食管切除术相比，微创食管切除术（MIE）在老年食管癌患者中是否具有围手术期或长期益处。
2005年2月至2013年6月期间，407例70岁以上的患者因食管癌接受了食管切除术，其中89例接受了微创食管切除术，318例接受了开放食管切除术。进行了一项回顾性配对研究，以比较116例接受开放食管切除术或微创食管切除术的患者（58对）。根据年龄、性别、合并症、肿瘤位置、组织学、TNM分期和手术方式对患者进行配对。比较两组的围手术期和长期结局。
微创食管切除术组术后并发症的总发生率显著低于开放食管切除术组（37.9%对60.3%，P = 0.016），尤其是肺部并发症的发生率（20.7%对39.7%，P = 0.026）。平均住院时间也显著缩短（10天[范围7 - 70天]对12天[范围8 - 106天]，P = 0.032）。微创食管切除术组围手术期死亡率呈下降趋势，但差异无统计学意义（3.4%对8.6%，P = 0.435）。Kaplan-Meier分析显示，微创食管切除术组的疾病特异性生存时间中位数显著长于开放食管切除术组（>27个月[范围1 - 82个月]对24个月[范围1 - 99个月]，P = 0.003）。总生存期无差异（39 ± 8.9个月对22 ± 3.4个月，P = 0.070）。
在老年食管癌患者的手术治疗中，微创食管切除术与较低的发病率和肺部并发症发生率以及较长的疾病特异性生存时间相关。其是否对患者的长期生存有益需要进一步研究。
