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杂交胸腔镜食管癌切除术治疗癌症——回顾性分析及与经裂孔切除术的比较

Hybrid thoracoscopic esophagectomy for cancer - retrospective analysis and comparison with transhiatal resection.

作者信息

Jínek T, Adamcik L, Duda M, Skrovina M

出版信息

Rozhl Chir. 2018 Spring;97(7):320-327.


DOI:
PMID:30442013
Abstract

INTRODUCTION: Minimally invasive methods for esophagectomy have been introduced to reduce postoperative complications. This paper compares open transhiatal esophagectomy and minimally invasive hybrid esophagectomy. Both methods have different extents of lymphadenectomy, transhiatal esophagectomy being considered less radical. METHOD: A single-centre retrospective study comprised 39 patients subjected to transhiatal esophagectomy and 25 patients subjected to hybrid esophagectomy combining thoracoscopy with laparotomy and cervical anastomosis. All patients were operated for middle and distal third carcinoma of the esophagus, including cardia (Siewert II), in the period of 2006-2016 at the Surgery department of Nový Jičín hospital. The data of both groups, in particular the incidence of early postoperative complications and the number of dissected lymph nodes, were statistically compared. Complications are reported according to the International Consensus on Standardization of Data Collection for Complications Associated with Esophagectomy. RESULTS: The duration of operation was significantly longer in the group that underwent hybrid resections (345 vs. 240 min, p<0.001). The number of dissected lymph nodes was comparable in both groups (15 vs. 16, p=0.072). Postoperative pulmonary complications were lower for hybrid operations (16% vs. 30.8%, p=0.243). The most common complication of transhiatal esophagectomy was pleural effusion requiring drainage, which occurred in 7 patients. The most common pulmonary complication of hybrid procedures was respiratory failure, which occurred in 3 patients. Anastomotic leak occurred in 5 patients after transhiatal esophagectomy and in one after thoracoscopic resection (12.8% vs. 4%, p=0.391). 30-day and 90-day mortality was nonsignificantly lower for hybrid resections (0% vs. 5.1%, p=0.516 and 4% vs. 10.3%, p=0.64). Following transhiatal esophagectomy, two patients died as a result of respiratory complications, one died from necrosis of the gastric tube and one from acute myocardial infarction. In the hybrid group, one patient died from respiratory failure. Hybrid resection exhibited lower morbidity (36% vs. 59%, p=0.123). The number of overall complications, irrespective of their severity according to the Clavien-Dindo classification, was statistically in favor of hybrid resection (11 vs. 30, p=0.015). CONCLUSION: In our study, we found that thoracoscopic hybrid resection was a feasible and well-executable method, with a statistically lower incidence of postoperative complications. Thoracoscopy allows lymphadenectomy to be performed to sufficient extent. The large number and various combinations of esophagectomy techniques make it difficult to evaluate and compare the outcomes of individual methods. Preference for a specific resection technique within a given surgical department remains an important factor as clear recommendations for esophageal resections do not yet exist. However, the use of minimally invasive techniques in esophageal resections is gradually becoming a standard. Key words: minimally invasive esophagectomy - thoracoscopy - postoperative complications - lymphadenectomy.

摘要

引言:为减少术后并发症,已引入微创食管切除术方法。本文比较开放经裂孔食管切除术和微创杂交食管切除术。两种方法的淋巴结清扫范围不同,经裂孔食管切除术被认为根治性较差。 方法:一项单中心回顾性研究纳入了39例行经裂孔食管切除术的患者和25例行胸腔镜联合剖腹术及颈部吻合的杂交食管切除术的患者。所有患者均于2006年至2016年在新伊钦医院外科接受食管中下段癌(包括贲门癌,Siewert II型)手术。对两组数据,尤其是术后早期并发症发生率和清扫淋巴结数量进行统计学比较。并发症按《食管切除术后并发症数据收集标准化国际共识》报告。 结果:杂交切除术组的手术时间明显更长(345分钟对240分钟,p<0.001)。两组清扫淋巴结数量相当(15个对16个,p=0.072)。杂交手术的术后肺部并发症较低(16%对30.8%,p=0.243)。经裂孔食管切除术最常见的并发症是需要引流的胸腔积液,7例患者发生。杂交手术最常见的肺部并发症是呼吸衰竭,3例患者发生。经裂孔食管切除术后5例患者发生吻合口漏,胸腔镜切除术后1例发生(12.8%对4%,p=0.391)。杂交切除术的30天和90天死亡率略低但无统计学意义(0%对5.1%,p=0.516;4%对10.3%,p=0.64)。经裂孔食管切除术后,2例患者死于呼吸并发症,1例死于胃管坏死,1例死于急性心肌梗死。杂交组1例患者死于呼吸衰竭。杂交切除术的发病率较低(36%对59%,p=0.123)。根据Clavien-Dindo分类,无论并发症严重程度如何,总体并发症数量在统计学上有利于杂交切除术(11例对30例,p=0.015)。 结论:在我们的研究中,我们发现胸腔镜杂交切除术是一种可行且易于实施的方法,术后并发症发生率在统计学上较低。胸腔镜检查可进行充分的淋巴结清扫。食管切除术技术的种类繁多及各种组合使得难以评估和比较个体方法的结果。在特定外科科室中对特定切除技术的偏好仍然是一个重要因素,因为目前尚无关于食管切除术的明确推荐。然而,在食管切除术中使用微创技术正逐渐成为标准。关键词:微创食管切除术 - 胸腔镜检查 - 术后并发症 - 淋巴结清扫

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