Nilsson Magnus, Kamiya Satoshi, Lindblad Mats, Rouvelas Ioannis
Department of Surgery, Center for Digestive Diseases, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
J Thorac Dis. 2017 Jul;9(Suppl 8):S817-S825. doi: 10.21037/jtd.2017.04.23.
Esophagectomy remains the gold standard in the curative intent treatment of resectable esophageal cancer. However, this procedure is complex and associated with high risk of complications. In an effort to reduce the postoperative morbidity associated with open esophagectomy various minimally invasive techniques have been introduced and developed during the recent years. The aim of the current study was to present our 4.5-year experience of the gradual implementation of various minimally invasive esophagectomy (MIE) techniques in our tertiary referral center.
From May 2012 a transitional period from conventional open esophagectomy to MIE was initiated. This period was preceded by fellowships and visits to expert centers abroad. Thereafter, a gradual implementation and refinement of the new techniques followed. Technique related data were collected prospectively.
Between January 1 2011 and December 31 2016 a total of 249 patients underwent an esophagectomy in our unit. Seventy-six cases were performed through a conventional open esophagectomy and 173 by some type of MIE. An increasing utilization of MIE over this time period was seen and finally reached 100% of treatment intentions, during the last 2 years. Ten cases (5.7%) where converted to open approach. A decrease in leak rate, operating time, peroperative bleeding and hospital stay as well as an increasing number of harvested lymph nodes was observed during the implementation period.
The transition from conventional open esophagectomy to MIE was successful at our center. The implementation was overall safe with good postoperative outcomes, although changes in results required technical modifications over time.
食管切除术仍然是可切除食管癌根治性治疗的金标准。然而，该手术复杂且并发症风险高。近年来，为了降低与开放性食管切除术相关的术后发病率，已引入并开发了各种微创技术。本研究的目的是介绍我们在三级转诊中心逐步实施各种微创食管切除术（MIE）技术的4.5年经验。
从2012年5月开始了从传统开放性食管切除术到MIE的过渡期。在此期间之前，我们的医生到国外的专家中心进修学习。此后，逐步实施并完善新技术。前瞻性收集技术相关数据。
在2011年1月1日至2016年12月31日期间，我们科室共有249例患者接受了食管切除术。其中76例通过传统开放性食管切除术进行，173例通过某种类型的MIE进行。在此期间，MIE的使用率不断提高，在最后两年最终达到了100%的治疗意向。有10例（5.7%）转为开放手术。在实施期间，观察到渗漏率、手术时间、术中出血和住院时间减少，以及收获的淋巴结数量增加。
在我们中心，从传统开放性食管切除术到MIE的转变是成功的。尽管随着时间的推移，结果的变化需要技术改进，但总体实施是安全的，术后效果良好。
