Japan Esophageal Oncology Group of Japan Clinical Oncology Group (JCOG), Tokyo, Japan.
Department of Surgery, Shikoku Cancer Center Hospital, 160 Minami-umemoto, Matsuyama, 791-0280, Japan.
Surg Endosc. 2018 Feb;32(2):651-659. doi: 10.1007/s00464-017-5716-5. Epub 2017 Aug 4.
Postoperative pulmonary complications (PPCs) are the most common causes of serious morbidity after esophagectomy, which involves both thoracic and abdominal incisions. Although the thoracoscopic approach decreases PPC frequency after esophagectomy, it remains unclear whether the frequency is further decreased by combining it with laparoscopic gastric mobilization. This study aimed to determine the impact of laparoscopy on the prevention of PPCs after thoracoscopic esophagectomy using data from the Japan Clinical Oncology Group Study 0502 (JCOG0502).
JCOG0502 is a four-arm prospective study comparing esophagectomy with definitive chemo-radiotherapy. The use of thoracoscopy and/or laparoscopy was decided at the surgeon's discretion. PPCs were defined as one or more of the following postoperative morbidities grade ≥2 (as per Common Terminology Criteria for Adverse Events v3.0): pneumonia, atelectasis, and acute respiratory distress syndrome.
A total of 379 patients were enrolled in JCOG0502. Of these, 210 patients underwent esophagectomy via thoracotomy with laparotomy (n = 102), thoracotomy with laparoscopy (n = 7), thoracoscopy with laparotomy (n = 43), and thoracoscopy with laparoscopy (n = 58). PPC frequency was reduced to a greater extent by thoracoscopy than by thoracotomy (thoracoscopy 15.8%, thoracotomy 30.3%; p = 0.015). However, following thoracoscopic esophagectomy, laparoscopy failed to further decrease the PPC frequency compared with laparotomy (laparoscopy 15.5%, laparotomy 16.3%; p = 1.00). Univariable analysis showed that thoracoscopy (shown above) and less blood loss (<350 mL 16.3%, ≥350 mL 30.2%; p = 0.022) were associated with PPC prevention, whereas laparoscopy showed a borderline significant association (laparoscopy 15.4%, laparotomy 26.9%; p = 0.079). Multivariable analysis also showed that thoracoscopy and less blood loss were associated with PPC prevention.
Thoracoscopic approach to esophagectomy significantly reduced PPC frequency with minimal additional effect from laparoscopic gastric mobilization.
术后肺部并发症（PPCs）是食管癌术后发生严重并发症的最常见原因，该手术涉及胸部和腹部切口。虽然胸腔镜方法可降低食管癌手术后 PPC 的发生率，但联合腹腔镜胃游离术是否会进一步降低其发生率尚不清楚。本研究旨在使用日本临床肿瘤学组研究 0502（JCOG0502）的数据，确定腹腔镜对预防胸腔镜食管癌手术后 PPC 的影响。
JCOG0502 是一项四臂前瞻性研究，比较了食管癌根治性放化疗与手术治疗。胸腔镜和/或腹腔镜的使用由外科医生决定。PPC 定义为以下一种或多种术后并发症≥2 级（根据不良事件通用术语标准 v3.0）：肺炎、肺不张和急性呼吸窘迫综合征。
JCOG0502 共纳入 379 例患者。其中，210 例行开胸剖腹手术（n=102）、开胸腹腔镜手术（n=7）、胸腔镜剖腹手术（n=43）和胸腔镜腹腔镜手术（n=58）。与开胸手术相比，胸腔镜手术可显著降低 PPC 的发生率（胸腔镜 15.8%，开胸 30.3%；p=0.015）。然而，在胸腔镜食管癌手术后，与开腹手术相比，腹腔镜并未进一步降低 PPC 的发生率（腹腔镜 15.5%，开腹 16.3%；p=1.00）。单变量分析显示，胸腔镜（如上文所示）和出血量较少（<350 mL 16.3%，≥350 mL 30.2%；p=0.022）与 PPC 的预防有关，而腹腔镜有边缘显著相关性（腹腔镜 15.4%，开腹 26.9%；p=0.079）。多变量分析也显示，胸腔镜和出血量较少与 PPC 的预防有关。
胸腔镜食管癌手术显著降低了 PPC 的发生率，腹腔镜胃游离术的效果甚微。
