Dolan James P, McLaren Patrick J, Diggs Brian S, Schipper Paul H, Tieu Brandon H, Sheppard Brett C, Gilbert Erin W, Conroy Molly A, Hunter John G
1 Division of Gastrointestinal & General Surgery, Department of Surgery, the Knight Cancer Institute, Oregon Health & Science University , Portland, Oregon.
2 Division of Cardiothoracic Surgery, Section of General Thoracic Surgery, Department of Surgery, Oregon Health & Science University , Portland, Oregon.
J Laparoendosc Adv Surg Tech A. 2017 Sep;27(9):915-923. doi: 10.1089/lap.2017.0069. Epub 2017 May 9.
Management of benign and malignant esophageal disease has changed rapidly over the past decade. The aim of this study was to analyze evolution in surgical management of esophageal disease at a single academic medical center during this period.
We reviewed a retrospective cohort of patients who underwent esophagectomy between 2004 and 2013. Patient, institutional, treatment, and outcomes variables were reviewed.
317 patients were analyzed. Median age was 63.5 years; 80% were male. Average inhospital mortality rate was 3.8%. Operative indications changed significantly from 2004 to 2013, with more operations performed for invasive malignancy (77% vs. 95%) and fewer for high-grade dysplasia (12% vs. 3%, P = .008). In 2004, Ivor Lewis esophagectomy was the most common surgical technique, but the three-field technique was the operation of choice in 2013. A minimally invasive approach was used in 19% of cases in 2004 and 100% of cases in 2013 (P < .001). Anastomotic leak ranged from 0% to 21% with no significant difference over the study period (P = .18). Median lymph node harvest increased from seven to 18 nodes from 2004 to 2013 (P = .001). Hospital length of stay decreased from 15 to 8 days (P = .001). In 2013, 79% of patients were discharged to home, compared to 73% in 2004 (P = .04).
Over the last decade, our treatment of esophageal disease has evolved from a predominantly open Ivor Lewis to a minimally invasive three-field approach. Operations for malignancy have also increased dramatically. Postoperative complications and mortality were not significantly changed, but were consistently low during the latter years of the study.
在过去十年中，良性和恶性食管疾病的治疗方法发生了迅速变化。本研究的目的是分析在此期间一家学术医疗中心食管疾病手术治疗的演变情况。
我们回顾了2004年至2013年间接受食管切除术的患者的回顾性队列。对患者、机构、治疗和结果变量进行了审查。
分析了317例患者。中位年龄为63.5岁；80%为男性。平均住院死亡率为3.8%。从2004年到2013年，手术适应症发生了显著变化，侵袭性恶性肿瘤的手术例数增加（77%对95%），高级别发育异常的手术例数减少（12%对3%，P = 0.008）。2004年，艾弗·刘易斯食管切除术是最常见的手术技术，但2013年三野手术是首选术式。2004年19%的病例采用了微创方法，2013年为100%（P < 0.001）。吻合口漏率在0%至21%之间，在研究期间无显著差异（P = 0.18）。从2004年到2013年，中位淋巴结清扫数从7个增加到18个（P = 0.001）。住院时间从15天减少到8天（P = 0.001）。2013年，79%的患者出院回家，2004年为73%（P = 0.04）。
在过去十年中，我们对食管疾病的治疗已从主要的开放性艾弗·刘易斯手术演变为微创三野手术。恶性肿瘤的手术例数也大幅增加。术后并发症和死亡率没有显著变化，但在研究后期一直较低。
