Bjelovic M, Babic T, Spica B, Gunjic D, Veselinovic M, Trajkovic G
Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia, Dr Koste Todorovica Street No 6, Belgrade 11000, Serbia; University of Belgrade, School of Medicine, Dr Subotica Street No 8, Belgrade 11000, Serbia.
Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia, Dr Koste Todorovica Street No 6, Belgrade 11000, Serbia.
Eur J Surg Oncol. 2016 Aug;42(8):1196-201. doi: 10.1016/j.ejso.2016.05.027. Epub 2016 Jun 2.
To assess the effectiveness of hybrid minimally invasive esophagectomy (hMIE) in comparison with open esophagectomy (OE) in esophageal cancer treatment.
The single center prospective nonrandom cohort study included a total of 88 patients in convenience sample, who underwent the Ivor-Lewis procedure with a curative intention for the middle- and lower-third esophageal cancer between January 2009 and February 2015. All patients were operated by the one surgical team. Out of 88 patients, 44 underwent OE and 44 hMIE laparoscopic approach (laparoscopic gastric mobilization). Primary endpoints were significant early postoperative complications, including major postoperative pulmonary complications (MPPCs). Secondary endpoints were perioperative characteristics, 30-day mortality and oncological outcomes.
The total number of complications was 21 in the OE group vs. 13 in the hMIE group (p > 0.05). Higher prevalence of major postoperative pulmonary complications (MPPCs) was observed in the OE group compared to the hMIE group. Mean intensive care unit (ICU) stay was 3.8 (1-21) days; there was a statistically significant difference in favor of the hMIE group. Mean number of harvested lymph nodes was 26.3 in the OE group compared to 31.9 in the hMIE group (p < 0.05). There was no statistically significant difference regarding 30-day mortality between the groups. Overall median survival rate was 807 days; 824 days in the OE group vs. 778 days in the hMIE group (p > 0.05).
Perioperative and oncologic results after hMIE are not inferior but are even better in some aspects of treatment when compared to OE.
评估杂交微创食管切除术（hMIE）与开放食管切除术（OE）在食管癌治疗中的有效性。
这项单中心前瞻性非随机队列研究共纳入88例便利样本患者，这些患者在2009年1月至2015年2月期间接受了具有治愈意图的Ivor-Lewis手术，用于治疗食管中下段癌。所有患者均由同一手术团队进行手术。88例患者中，44例行OE，44例行hMIE腹腔镜入路（腹腔镜下胃游离）。主要终点是术后早期严重并发症，包括术后主要肺部并发症（MPPCs）。次要终点是围手术期特征、30天死亡率和肿瘤学结局。
OE组并发症总数为21例，hMIE组为13例（p>0.05）。与hMIE组相比，OE组术后主要肺部并发症（MPPCs）的发生率更高。重症监护病房（ICU）平均住院时间为3.8（1-21）天；hMIE组具有统计学显著差异。OE组平均清扫淋巴结数为26.3个，hMIE组为31.9个（p<0.05）。两组间30天死亡率无统计学显著差异。总体中位生存率为807天；OE组为824天，hMIE组为778天（p>0.05）。
与OE相比，hMIE术后的围手术期和肿瘤学结果并不逊色，甚至在某些治疗方面更好。
