Gastrointestinal Oncology, Florida State University College Of Medicine/Sarasota Memorial Health Care System, 1950 Arlington Street, Suite 101, Sarasota, FL, 34239, USA.
Radiation Oncology, University of Central Florida, Orlando, FL, USA.
J Gastrointest Surg. 2020 Jun;24(6):1261-1268. doi: 10.1007/s11605-019-04269-y. Epub 2019 Jun 13.
Surgical resection is vital in the curative management of patients with esophageal cancer. However, a myriad of surgical procedures exists based on surgeon preference and training. We report on the perioperative outcomes based on esophagectomy surgical technique.
A prospectively managed esophagectomy database was queried for patients undergoing esophagectomy from 1996 and 2016. Basic demographics, tumor characteristics, operative details, and post-operative outcomes were recorded and analyzed by comparison of transhiatal vs Ivor-lewis and minimally invasive (MIE) vs open procedures.
We identified 856 patients who underwent esophagectomy. Neoadjuvant therapy was administered in 543 patients (63.4%). There were 504 (58.8%) open esophagectomies and 302 (35.2%) MIE. There were 13 (1.5%) mortalities and this did not differ among techniques (p = 0.6). While there was no difference in overall complications between MIE and open, complications occurred less frequently in patients undergoing RAIL and MIE IVL compared to other techniques (p = 0.003). Pulmonary complications also occurred less frequently in RAIL and MIE IVL (p < 0.001). Anastomotic leaks were less common in patients who underwent IVL compared to trans-hiatal approaches (p = 0.03). MIE patients were more likely to receive neoadjuvant therapy (p = 0.001), have lower blood loss (p < 0.001), have longer operations (p < 0.001), and higher lymph node harvests (p < 0.001) compared to open patients.
Minimally invasive and robotic Ivor Lewis techniques demonstrated substantial benefits in post-operative complications. Oncologic outcomes similarly favor MIE IVL and RAIL.
手术切除对于食管癌患者的治疗至关重要。然而，根据外科医生的偏好和培训，存在多种手术方法。我们报告了基于食管癌切除术技术的围手术期结果。
通过比较经胸入路与 Ivor-Lewis 入路以及微创（MIE）与开放手术，对 1996 年至 2016 年接受食管癌切除术的患者的前瞻性管理食管癌切除术数据库进行了查询。记录并分析了基本人口统计学、肿瘤特征、手术细节和术后结果。
我们共确定了 856 例接受食管癌切除术的患者。543 例患者（63.4%）接受了新辅助治疗。504 例（58.8%）为开放性食管癌切除术，302 例（35.2%）为 MIE。有 13 例（1.5%）死亡，不同技术之间的死亡率没有差异（p=0.6）。尽管 MIE 和开放组之间的总体并发症无差异，但 RAIL 和 MIE IVL 组的并发症发生率低于其他技术（p=0.003）。RAIL 和 MIE IVL 组的肺部并发症也较少（p<0.001）。与经胸入路相比，IVL 组的吻合口漏发生率较低（p=0.03）。与开放组相比，MIE 组更有可能接受新辅助治疗（p=0.001），出血量更少（p<0.001），手术时间更长（p<0.001），淋巴结清扫更多（p<0.001）。
微创和机器人 Ivor Lewis 技术在术后并发症方面显示出显著优势。MIE IVL 和 RAIL 同样有利于肿瘤学结果。
