Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176, Stockholm, Sweden.
Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
Ann Surg Oncol. 2018 Jan;25(1):326-332. doi: 10.1245/s10434-017-6212-9. Epub 2017 Nov 1.
Population-based studies comparing minimally invasive esophagectomy (MIE) and open esophagectomy (OE) relative to 90-day postoperative mortality are needed.
The aim of this study was to compare short-term outcomes following these two techniques for esophageal cancer.
Patients undergoing MIE (n = 217) or OE (n = 1397) for esophageal cancer between 2007 and 2014 were identified from nationwide complete registries in Finland and Sweden. The primary outcome was 90-day mortality, and secondary outcomes were 30-day mortality, length of hospital stay, and 30- and 90-day readmission rate. Results were adjusted for age, sex, comorbidity, tumor histology, surgery year, and country.
Ninety-day mortality rates were 4.1% (n = 9 of 217) for MIE and 6.8% (n = 95 of 1397) for OE; 90-day mortality was halved after MIE [adjusted hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.24-0.99]. There was no difference in 30-day mortality (adjusted HR 0.87, 95% CI 0.29-2.66). Median hospital stay was 15 days for MIE and 16 days for OE (adjusted β -0.17, standard error 0.08, p = 0.030). The 30-day readmission rates were 8.9% after MIE and 12.0% after OE (adjusted HR 0.57, 95% CI 0.34-0.94), while the 90-day readmission rates were 28.8% and 33.6%, respectively, without a statistically significant difference (adjusted HR 0.82, 95% CI 0.61-1.10).
This population-based study from Finland and Sweden revealed lower 90-day mortality, shorter hospital stay, and lower 30-day readmission rates after MIE compared with OE for esophageal cancer. These findings support the use of minimally invasive approaches.
需要开展基于人群的研究，比较微创食管切除术（MIE）和开放食管切除术（OE）与术后 90 天死亡率的关系。
本研究旨在比较这两种技术治疗食管癌的短期疗效。
本研究从芬兰和瑞典的全国性完整登记处中确定了 2007 年至 2014 年间接受 MIE（n=217）或 OE（n=1397）治疗的食管癌患者。主要结局为 90 天死亡率，次要结局为 30 天死亡率、住院时间、30 天和 90 天再入院率。结果经年龄、性别、合并症、肿瘤组织学、手术年份和国家调整。
MIE 的 90 天死亡率为 4.1%（n=217），OE 为 6.8%（n=1397）；MIE 后 90 天死亡率减半[调整后的危险比（HR）0.49，95%置信区间（CI）0.24-0.99]。30 天死亡率无差异（调整 HR 0.87，95%CI 0.29-2.66）。MIE 的中位住院时间为 15 天，OE 为 16 天（调整β-0.17，标准误差 0.08，p=0.030）。MIE 后 30 天再入院率为 8.9%，OE 为 12.0%（调整 HR 0.57，95%CI 0.34-0.94），90 天再入院率分别为 28.8%和 33.6%，差异无统计学意义（调整 HR 0.82，95%CI 0.61-1.10）。
本研究从芬兰和瑞典的人群中发现，与 OE 相比，MIE 治疗食管癌可降低 90 天死亡率、缩短住院时间、降低 30 天再入院率，支持微创方法的应用。
