Cola Carlos Bernardo, Sabino Flávio Duarte, Pinto Carlos Eduardo, Morard Maria Ribeiro, Portari Pedro, Guedes Tereza
- National Cancer Institute (INCA/MS), Abdomino-pelvic Surgery Section - Rio de Janeiro, RJ, Brazil.
- Federal University of the State of Rio de Janeiro (Unirio), Department of General Surgery, Postgraduate Program in Medicine (PPGMED) / Professional Master's Degree, Rio de Janeiro, RJ, Brazil.
Rev Col Bras Cir. 2017 Sep-Oct;44(5):428-434. doi: 10.1590/0100-69912017005002.
to analyze the National Cancer Institute Abdominopelvic Division (INCA / MS/HC I) initial experience with thoraco-laparoscopic esophagectomy with thoracic stage in prone position.
we studied 19 consecutive thoraco-laparoscopic esophagectomies from may 2012 to august 2014, including ten patients with squamous cells carcinoma (five of the middle third and five of the lower third) and nine cases of gastroesophageal junction adenocarcinoma (six Siewert I and three Siewert II). All procedures were initiated by the prone thoracic stage.
There were minimal blood loss, optimal mediastinal visualization, oncological radicality and no conversions. Surgical morbidity was 42 %, most being minor complications (58% Clavien I or II), with few related to the technique. The most common complication was cervical anastomotic leak (37%), with a low anastomotic stricture rate (two stenosis: 10.53%). We had one (5.3%) surgical related death, due to a gastric tube`s mediastinal leak, treated by open reoperation and neck diversion. The median Intensive Care Unit stay and hospital stay were two and 12 days, respectively. The mean thoracoscopic stage duration was 77 min. Thirteen patients received neoadjuvant treatment (five squamous cells carcinoma and eight gastroesophageal adenocarcinomas). The average lymph node sample had 16.4 lymph nodes per patient and 22.67 when separately analyzing patients without neoadjuvant treatment.
the thoraco-laparoscopic approach was a safe technique in the surgical treatment of esophageal cancer, with a good lymph node sampling.
分析国家癌症研究所腹部盆腔科（INCA/MS/HC I）在俯卧位下进行胸腹腔镜联合食管癌切除术治疗胸段食管癌的初步经验。
我们研究了2012年5月至2014年8月期间连续进行的19例胸腹腔镜联合食管癌切除术，其中包括10例鳞状细胞癌患者（中段5例，下段5例）和9例胃食管交界腺癌患者（Siewert I型6例，Siewert II型3例）。所有手术均从俯卧位胸段手术开始。
术中出血极少，纵隔视野良好，肿瘤切除彻底，无中转开腹。手术并发症发生率为42%，多数为轻微并发症（58%为Clavien I或II级），与手术技术相关的较少。最常见的并发症是颈部吻合口漏（37%），吻合口狭窄率较低（2例狭窄：10.53%）。我们有1例（5.3%）手术相关死亡，原因是胃管纵隔漏，通过开腹再次手术和颈部转流治疗。重症监护病房（ICU）中位住院时间和住院总时间分别为2天和12天。平均胸腔镜手术阶段持续时间为77分钟。13例患者接受了新辅助治疗（5例鳞状细胞癌和8例胃食管腺癌）。平均每例患者获取的淋巴结样本数为16.4个，未接受新辅助治疗的患者单独分析时为22.67个。
胸腹腔镜联合手术是食管癌手术治疗的一种安全技术，淋巴结采样良好。
