Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Clinical Trial Planning and Management, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
Surg Endosc. 2018 Nov;32(11):4443-4450. doi: 10.1007/s00464-018-6187-z. Epub 2018 Apr 11.
Minimally invasive esophagectomy (MIE) for patients with esophageal cancer has recently spread worldwide. However, whether MIE is less invasive has not yet been fully evaluated.
We retrospectively analyzed data from 551 patients who underwent curative esophagectomy for esophageal cancer from 2005 to 2014: 145 patients underwent minimally invasive esophagectomy (MIE) and 406 patients underwent open transthoracic esophagectomy (OE). We compared postoperative CRP levels with propensity score matching. In addition, long-term outcomes were also compared between the groups.
Operative time was significantly longer, and intraoperative blood loss was significantly less in the MIE group compared with the OE group. Although the incidence of postoperative complications was similar between the 2 groups, postoperative serum CRP levels during the first 3 and 5 postoperative days and peak postoperative CRP levels were significantly lower after MIE versus OE (MIE vs. OE, median, 15.21 vs. 19.50 mg/dl; P < 0.001). The MIE group had significantly more favorable disease-free survival (DFS) and overall survival (OS) rates than the OE group (3-year DFS rate, 81.7 vs. 69.3%, log-rank P = 0.021; 3-year OS rate, 89.9 vs. 79.2%, log-rank P = 0.007). MIE was an independent prognostic factor for patients with esophageal cancer. The incidence of regional lymph node recurrence was lower in the MIE group.
MIE significantly attenuated postoperative serum CRP levels compared with OE. MIE could contribute to improved survival.
对于食管癌患者，微创食管切除术（MIE）最近已在全球范围内得到推广。然而，MIE 是否具有更小的侵袭性尚未得到充分评估。
我们回顾性分析了 2005 年至 2014 年期间接受根治性食管癌切除术的 551 例患者的数据：145 例患者接受微创食管切除术（MIE），406 例患者接受经胸开放性食管切除术（OE）。我们通过倾向评分匹配比较术后 CRP 水平。此外，还比较了两组的长期结果。
与 OE 组相比，MIE 组的手术时间明显更长，术中出血量明显更少。尽管两组术后并发症发生率相似，但 MIE 组术后第 3 天和第 5 天以及术后 CRP 峰值明显低于 OE 组（MIE 与 OE，中位数，15.21 与 19.50mg/dl；P<0.001）。MIE 组的无病生存率（DFS）和总生存率（OS）明显优于 OE 组（3 年 DFS 率，81.7%与 69.3%，对数秩 P=0.021；3 年 OS 率，89.9%与 79.2%，对数秩 P=0.007）。MIE 是食管癌患者的独立预后因素。MIE 组区域淋巴结复发率较低。
与 OE 相比，MIE 明显降低了术后血清 CRP 水平。MIE 可能有助于改善生存。
