Yanasoot Alongkorn, Yolsuriyanwong Kamtorn, Ruangsin Sakchai, Laohawiriyakamol Supparerk, Sunpaweravong Somkiat
Department of Surgery, Faculty of Medicine, 26686 Prince of Songkla University, Songkla, Thailand.
Asian Cardiovasc Thorac Ann. 2017 Sep-Oct;25(7-8):513-517. doi: 10.1177/0218492317731389. Epub 2017 Sep 5.
Background A minimally invasive approach to esophagectomy is being used increasingly, but concerns remain regarding the feasibility, safety, cost, and outcomes. We performed an analysis of the costs and benefits of minimally invasive, hybrid, and open esophagectomy approaches for esophageal cancer surgery. Methods The data of 83 consecutive patients who underwent a McKeown's esophagectomy at Prince of Songkla University Hospital between January 2008 and December 2014 were analyzed. Open esophagectomy was performed in 54 patients, minimally invasive esophagectomy in 13, and hybrid esophagectomy in 16. There were no differences in patient characteristics among the 3 groups Minimally invasive esophagectomy was undertaken via a thoracoscopic-laparoscopic approach, hybrid esophagectomy via a thoracoscopic-laparotomy approach, and open esophagectomy by a thoracotomy-laparotomy approach. Results Minimally invasive esophagectomy required a longer operative time than hybrid or open esophagectomy ( p = 0.02), but these patients reported less postoperative pain ( p = 0.01). There were no significant differences in blood loss, intensive care unit stay, hospital stay, or postoperative complications among the 3 groups. Minimally invasive esophagectomy incurred higher operative and surgical material costs than hybrid or open esophagectomy ( p = 0.01), but there were no significant differences in inpatient care and total hospital costs. Conclusion Minimally invasive esophagectomy resulted in the least postoperative pain but the greatest operative cost and longest operative time. Open esophagectomy was associated with the lowest operative cost and shortest operative time but the most postoperative pain. Hybrid esophagectomy had a shorter learning curve while sharing the advantages of minimally invasive esophagectomy.
背景 微创食管切除术的应用日益广泛，但在可行性、安全性、成本和疗效方面仍存在担忧。我们对食管癌手术的微创、杂交和开放食管切除术方法的成本和效益进行了分析。方法 分析了2008年1月至2014年12月在宋卡王子大学医院连续接受麦克尤恩食管切除术的83例患者的数据。54例行开放食管切除术，13例行微创食管切除术，16例行杂交食管切除术。三组患者的特征无差异。微创食管切除术通过胸腔镜-腹腔镜入路进行，杂交食管切除术通过胸腔镜-剖腹入路进行，开放食管切除术通过开胸-剖腹入路进行。结果 微创食管切除术的手术时间比杂交或开放食管切除术长（p = 0.02），但这些患者术后疼痛较轻（p = 0.01）。三组患者在失血量、重症监护病房停留时间、住院时间或术后并发症方面无显著差异。微创食管切除术的手术和手术材料成本高于杂交或开放食管切除术（p = 0.01），但住院护理和总住院成本无显著差异。结论 微创食管切除术导致的术后疼痛最轻，但手术成本最高，手术时间最长。开放食管切除术的手术成本最低，手术时间最短，但术后疼痛最严重。杂交食管切除术的学习曲线较短，同时兼具微创食管切除术的优点。
