Khan Misbah, Ashraf Muhammad Ijaz, Syed Aamir Ali, Khattak Shahid, Urooj Namra, Muzaffar Anam
Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH and RC), Lahore, Pakistan.
J Minim Access Surg. 2017 Jul-Sep;13(3):192-199. doi: 10.4103/0972-9941.199606.
There has been an increasing inclination towards minimally invasive esophagectomies (MIEs) at our institute recently for resectable oesophageal cancer.
The purpose of the present study is to report peri-operative and long-term procedure specific outcomes of the two groups and analyse their changing pattern at our institute.
All adult patients with a diagnosis of oesophageal cancer managed at our institute from 2005 to 2015 were included in this retrospective study. Patients' demographic and clinical characteristics were recorded through our hospital information system. The cohort of esophagectomies was allocated into two groups, conventional open esophagectomy (OE) or total laparoscopic MIE; hybrid esophagectomies were taken as a separate group. The short-term outcome measures are an operative time in minutes, length of hospital and Intensive Care Unit (ICU) stay in days, post-operative complications and 30 days in-hospital mortality. Complications are graded according to the Clavien-Dindo classification system. Long-term outcomes are long-term procedure related complications over a minimum follow-up of 1 year. Trends were analysed by visually inspecting the graphic plots for mean number of events in each group each year.
Our results showed no difference in mortality, length of hospital and ICU stays and incidence of major complications between three groups on uni- and multi-variate analysis (P > 0.05). The operative time was significantly longer in MIE group (odds ratio [OR]: 1.66, confidence interval [CI]: 2.4-11.5). The incidence of long-term complication was low for MIE (OR: 1.0, CI: 133-1.017). However, all post-operative surgical outcomes trended to improve in both groups over the course of this study and stayed better for MIE group except for the operative time.
MIE has overall comparable surgical outcomes to its conventional counterpart. Furthermore, the peri-operative outcomes tend to improve in our centre with the maturation of program and experience.
最近我院对于可切除食管癌越来越倾向于采用微创食管切除术（MIE）。
本研究旨在报告两组患者的围手术期及长期特定手术结局，并分析其在我院的变化模式。
本回顾性研究纳入了2005年至2015年在我院接受治疗的所有成年食管癌患者。通过我院医院信息系统记录患者的人口统计学和临床特征。食管切除术队列分为两组，传统开放食管切除术（OE）或全腹腔镜MIE；杂交食管切除术作为单独一组。短期结局指标包括手术时间（分钟）、住院时间和重症监护病房（ICU）住院天数、术后并发症及30天院内死亡率。并发症根据Clavien-Dindo分类系统分级。长期结局为至少随访1年的长期手术相关并发症。通过直观检查每组每年事件平均数的图表来分析趋势。
单因素和多因素分析显示，三组在死亡率、住院时间和ICU住院时间以及主要并发症发生率方面无差异（P>0.05）。MIE组手术时间明显更长（优势比[OR]：1.66，置信区间[CI]：2.4 - 11.5）。MIE的长期并发症发生率较低（OR：1.0，CI：133 - 1.017）。然而，在本研究过程中，两组的所有术后手术结局均呈改善趋势，除手术时间外，MIE组的结局更好。
MIE的总体手术结局与其传统手术相当。此外，随着项目和经验的成熟，我院的围手术期结局趋于改善。
