Scarpa M, Cavallin F, Saadeh L M, Pinto E, Alfieri R, Cagol M, Da Roit A, Pizzolato E, Noaro G, Pozza G, Castoro C
Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy.
Dis Esophagus. 2016 Nov;29(8):1064-1070. doi: 10.1111/dote.12418. Epub 2015 Sep 24.
The purpose of this case-control study was to evaluate the impact of hybrid minimally invasive esophagectomy for cancer on surgical stress response and nutritional status. All 34 consecutive patients undergoing hybrid minimally invasive esophagectomy for cancer at our surgical unit between 2008 and 2013 were retrospectively compared with 34 patients undergoing esophagectomy with open gastric tubulization (open), matched for neoadjuvant therapy, pathological stage, gender and age. Demographic data, tumor features and postoperative course (including quality of life and systemic inflammatory and nutritional status) were compared. Postoperative course was similar in terms of complication rate. Length of stay in intensive care unit was shorter in patients undergoing hybrid minimally invasive esophagectomy (P = 0.002). In the first postoperative day, patients undergoing hybrid minimally invasive esophagectomy had lower C-reactive protein levels (P = 0.001) and white cell blood count (P = 0.05), and higher albumin serum level (P = 0.001). In this group, albumin remained higher also at third (P = 0.06) and seventh (P = 0.008) postoperative day, and C-reactive protein resulted lower at third post day (P = 0.04). Hybrid minimally invasive esophagectomy significantly improved the systemic inflammatory and catabolic response to surgical trauma, contributing to a shorter length of stay in intensive care unit.
本病例对照研究的目的是评估杂交微创食管癌切除术对手术应激反应和营养状况的影响。回顾性比较了2008年至2013年间在我们外科单位连续接受杂交微创食管癌切除术的34例患者与34例接受开放胃管状化食管癌切除术（开放手术）的患者，这些患者在新辅助治疗、病理分期、性别和年龄方面相匹配。比较了人口统计学数据、肿瘤特征和术后病程（包括生活质量以及全身炎症和营养状况）。两组患者在并发症发生率方面术后病程相似。接受杂交微创食管癌切除术的患者在重症监护病房的住院时间较短（P = 0.002）。术后第一天，接受杂交微创食管癌切除术的患者C反应蛋白水平较低（P = 0.001），白细胞计数较低（P = 0.05），血清白蛋白水平较高（P = 0.001）。在该组中，术后第三天（P = 0.06）和第七天（P = 0.008）时白蛋白水平也较高，术后第三天C反应蛋白水平较低（P = 0.04）。杂交微创食管癌切除术显著改善了对手术创伤的全身炎症和分解代谢反应，有助于缩短在重症监护病房的住院时间。
