Lin Jihong, Kang Mingqiang, Lin Jiangbo, Chen Shuchen, Deng Fan, Han Wu, Lin Ruobai
Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2014 Sep;17(9):888-91.
To compare the perioperative complications between Ivor-Lewis approach and McKeown approach in minimally invasive esophagectomy and gastric tube reconstruction for the treatment of middle and lower thoracic esophageal cancer.
Retrospective analysis of clinical data was performed on 288 patients with middle and lower thoracic esophageal cancer who underwent completely minimally invasive esophagectomy by one surgical team in Fujian Medical University Union Hospital from December 2010 to March 2014. Among the 288 patients, 103 patients underwent combined laparoscopic and thoracoscopic esophagectomy and intrathoracic esophagogastric anastomosis using a transoral anvil(Orvil)(Ivor-Lewis group, 2-incision) and 185 patients underwent combined laparoscopic and thoracoscopic esophagectomy and cervical anastomosis(McKeown group, 3-incision). Patients were stratified by surgical approach and perioperative outcomes were compared between the two groups.
There were no statistical differences between two groups in intra-operative blood loss, conversion to open, extubation time, time to resume oral intake, postoperative hospital stay, the median number of lymph nodes resected. The operation time of Ivor-Lewis group was significantly shorter than that of McKeown group [(283.4±32.0) min vs. (303.6±43.7) min, P=0.003). The hospital cost of Ivor-Lewis group was significantly higher than that of McKeown group [(76 492±18 553) yuan vs. (68 923±17 331) yuan, P<0.01]. There were no statistical differences between two groups in chylothorax, delayed gastric emptying, atrial fibrillation, postoperative bleeding, admission to ICU, short-term postoperative mortality (P>0.05). The total postoperative complication morbidity of Ivor-Lewis group was significantly lower than that of McKeown group(16.5% vs. 31.4%, P<0.01). Ivor-Lewis group had lower pulmonary complication(8.7% vs. 25.9%, P<0.01), anastomotic leakage(1.9% vs. 13.0%, P<0.01), anastomotic stricture (0% vs. 4.9%, P<0.05), recurrent laryngeal nerve injury(1.0% vs. 7.0%, P<0.05).
Ivor-Lewis approach is associated with less postoperative complications, but higher cost as compared to McKeown approach in the treatment of middle and lower thoracic esophageal cancer.
比较Ivor-Lewis术式与McKeown术式在微创食管切除术及胃管重建治疗胸段中下段食管癌中的围手术期并发症。
回顾性分析2010年12月至2014年3月在福建医科大学附属协和医院由同一手术团队完成的288例胸段中下段食管癌患者的临床资料。288例患者中，103例行腹腔镜联合胸腔镜食管切除术并经口置入吻合器行胸内食管胃吻合术（Ivor-Lewis组，两切口），185例行腹腔镜联合胸腔镜食管切除术并颈部吻合术（McKeown组，三切口）。根据手术方式对患者进行分层，并比较两组的围手术期结局。
两组在术中出血量、中转开腹、拔管时间、恢复经口进食时间、术后住院时间、切除淋巴结中位数方面无统计学差异。Ivor-Lewis组手术时间显著短于McKeown组[（283.4±32.0）分钟 vs.（303.6±43.7）分钟，P = 0.003]。Ivor-Lewis组住院费用显著高于McKeown组[（76492±18553）元 vs.（68923±17331）元，P < 0.01]。两组在乳糜胸、胃排空延迟、心房颤动、术后出血、入住重症监护病房、术后短期死亡率方面无统计学差异（P > 0.05）。Ivor-Lewis组术后总并发症发生率显著低于McKeown组（16.5% vs. 31.4%，P < 0.01）。Ivor-Lewis组肺部并发症（8.7% vs. 25.9%，P < 0.01）、吻合口漏（1.9% vs. 13.0%，P < 0.01）、吻合口狭窄（0% vs. 4.9%，P < 0.05）、喉返神经损伤（1.0% vs. 7.0%，P < 0.05）发生率更低。
在治疗胸段中下段食管癌时，与McKeown术式相比，Ivor-Lewis术式术后并发症更少，但费用更高。
