Peng Xiong, Chen Yun, Nassor Juma Abdillah, Wang Yanqing, Zhou Yuan, Jiao Yang, Zhang Weixing, Zhuang Wei
Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China.
Department of Thoracic Surgery, People's Hospital of Cili County, Zhangjiajie Hunan 427200, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2017 May 28;42(5):546-552. doi: 10.11817/j.issn.1672-7347.2017.05.011.
To summarize the outcomes of 74 patients with minimally invasive McKeown esophagectomy (MIE-McKeown), and to discuss the short-term outcomes by comparing with Ivor-Lewis esophagectomy (ILE) procedure. Methods: A total of 74 patients with esophageal carcinoma underwent MIE-McKeown in Xiangya Hospital from November 2014 to July 2016 were retrospectively reviewed, and 85 patients underwent ILE procedure were selected as a control group. Perioperative and short-term outcomes were analyzed. Results: Compared with the ILE group, patients underwent MIE-McKeown had less blood loss, less pulmonary infection, longer resection length and more harvested lymph nodes (P<0.05), but they had more anastomotic leakage and stricture rate, longer operation time and hospital stay as well (P<0.05). The total rate of lymph node metastatic in all patients was 52.8%, and the rate of cervical lymph node metastases was 9.5% in the MIE-McKeown group. Multiple carcinomas were found in 16 cases, and 7 were proximally located. The distance from the distal margin of the second lesion to the center of the main lesion was 20-85 (50.7±23.0) mm, while the distance in 9 second carcinomas distally located was 30-90 (57.8±20.5) mm. Conclusion: Compared with Ivor-Lewis esophagectomy procedure, MIE-McKeown procedure has a more complete lesion dissection and more harvested lymph nodes with smaller incisions, better short-term outcomes and more safety. It is an appropriate procedure for esophagectomy. However, it should be optimized for its high rate of anastomotic leakage and stricture.
总结74例行微创McKeown食管癌切除术（MIE-McKeown）患者的手术结果，并通过与Ivor-Lewis食管癌切除术（ILE）对比，探讨其短期疗效。方法：回顾性分析2014年11月至2016年7月在湘雅医院行MIE-McKeown的74例食管癌患者，并选取85例行ILE手术的患者作为对照组，分析围手术期及短期疗效。结果：与ILE组相比，行MIE-McKeown的患者术中出血量少、肺部感染少、切除长度长、清扫淋巴结多（P<0.05），但吻合口漏及狭窄发生率高、手术时间长、住院时间长（P<0.05）。所有患者淋巴结转移率为52.8%，MIE-McKeown组颈部淋巴结转移率为9.5%。发现16例多发癌，其中7例位于近端。第二个病灶远端切缘至主病灶中心的距离为20～85（50.7±23.0）mm，而9例远端多发癌的距离为30～90（57.8±20.5）mm。结论：与Ivor-Lewis食管癌切除术相比，MIE-McKeown手术切口小，病变切除更彻底，清扫淋巴结更多，短期疗效更好，安全性更高，是一种合适的食管癌切除手术方式。然而，其吻合口漏及狭窄发生率高，需进一步优化。
