Department of Thoracic Surgery, Esophageal Cancer Division, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
Thorac Cancer. 2018 Jan;9(1):94-98. doi: 10.1111/1759-7714.12544. Epub 2017 Oct 30.
Minimally invasive esophagectomy (MIE) is increasingly performed worldwide. Unplanned events during thoracoscopy or laparoscopy can jeopardize the procedure, sometimes necessitating conversion to open surgery. The aim of this study was to evaluate the impact of unplanned events on early postoperative outcomes after MIE.
A consecutive group of 303 patients who underwent MIE between January 2011 and December 2015 were reviewed. The patients were allocated to two groups comprising those with (G-UPE, 85 patients) and without unplanned events (G-Regular, 218 patients). Unplanned events, defined as events that clearly changed or prolonged the procedure included intraoperative bleeding, chest and/or peritoneal adhesions, tumor invasion (sT4a + T4b), non-radical resection (R2 resection), and conversion for any reason. Differences in postoperative complications between the groups were analyzed.
The most common unplanned events were pleural and/or peritoneal adhesions (28/89, 31.5%), followed by intraoperative discovery of tumor invasion (sT4a + T4b, 25/89, 28.1%). There were significant differences in the incidence of respiratory (57.6% vs. 8.3%) and nervous system complications (10.6% vs. 2.7%), postoperative infection (32.9% vs. 5.0%), and chylothorax (8.2% vs. 0.9%) between the G-UPE and G-Regular groups, respectively (P < 0.05). The most common reasons for conversion to open procedures were pleural and/or peritoneal adhesions (9/38, 23.8%) and intraoperative bleeding (7/38, 18.4%). The main reasons for R2 resection were tumor invasion of the trachea or bronchus (7/21, 33.2%) and of the aorta (5/21, 23.8%).
Unplanned events during MIE increase the incidence of postoperative complications. Improved clinical staging and more careful surgery minimize unplanned events.
微创食管切除术（MIE）在全球范围内的应用日益增多。胸腔镜或腹腔镜手术中的意外事件可能会危及手术过程，有时需要转为开放性手术。本研究旨在评估 MIE 后早期术后并发症中意外事件的影响。
回顾性分析 2011 年 1 月至 2015 年 12 月期间接受 MIE 的 303 例连续患者。将患者分为两组：有（G-UPE，85 例）和无（G-Regular，218 例）意外事件组。意外事件定义为明显改变或延长手术的事件，包括术中出血、胸腔和/或腹膜粘连、肿瘤侵犯（sT4a + T4b）、非根治性切除（R2 切除）和因任何原因转为开放性手术。分析两组术后并发症的差异。
最常见的意外事件是胸腔和/或腹膜粘连（28/89，31.5%），其次是术中发现肿瘤侵犯（sT4a + T4b，25/89，28.1%）。G-UPE 组和 G-Regular 组在呼吸系统（57.6% vs. 8.3%）和神经系统并发症（10.6% vs. 2.7%）、术后感染（32.9% vs. 5.0%）和乳糜胸（8.2% vs. 0.9%）的发生率方面存在显著差异（P < 0.05）。转为开放性手术的最常见原因是胸腔和/或腹膜粘连（9/38，23.8%）和术中出血（7/38，18.4%）。R2 切除的主要原因是肿瘤侵犯气管或支气管（7/21，33.2%）和主动脉（5/21，23.8%）。
MIE 术中意外事件增加了术后并发症的发生率。提高临床分期和更仔细的手术可减少意外事件。
