比较微创与开放食管癌切除术治疗食管癌的围手术期死亡率和发病率：一项全国性回顾性分析。
Comparing Perioperative Mortality and Morbidity of Minimally Invasive Esophagectomy Versus Open Esophagectomy for Esophageal Cancer: A Nationwide Retrospective Analysis.
机构信息
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan.
出版信息
Ann Surg. 2021 Aug 1;274(2):324-330. doi: 10.1097/SLA.0000000000003500.
OBJECTIVE
We compared the surgical outcomes of minimally invasive esophagectomy (MIE) and open esophagectomy (OE) for esophageal cancer.
SUMMARY BACKGROUND DATA
MIE has become a widespread procedure. However, the definitive advantages of MIE over OE at a nationwide level have not been established.
METHODS
We analyzed patients who underwent esophagectomy for clinical stage 0 to III esophageal cancer from April 2014 to March 2017 using a Japanese inpatient database. We performed propensity score matching to compare in-hospital mortality and morbidities between MIE and OE, accounting for clustering of patients within hospitals.
RESULTS
Among 14,880 patients, propensity matching generated 4572 pairs. MIE was associated with lower incidences of in-hospital mortality (1.2% vs 1.7%, P = 0.048), surgical site infection (1.9% vs 2.6%, P = 0.04), anastomotic leakage (12.8% vs 16.8%, P < 0.001), blood transfusion (21.9% vs 33.8%, P < 0.001), reoperation (8.6% vs 9.9%, P = 0.03), tracheotomy (4.8% vs 6.3%, P = 0.002), and unplanned intubation (6.3% vs 8.4%, P < 0.001); a shorter postoperative length of stay (23 vs 26 days, P < 0.001); higher incidences of vocal cord dysfunction (9.2% vs 7.5%, P < 0.001) and prolonged intubation period after esophagectomy (23.2% vs 19.3%, P < 0.001); and a longer duration of anesthesia (408 vs 363 minutes, P < 0.001).
CONCLUSION
MIE had favorable outcomes in terms of in-hospital mortality, morbidities, and the postoperative hospital stay.
目的
我们比较了微创食管切除术（MIE）和开放食管切除术（OE）治疗食管癌的手术结果。
摘要背景数据
MIE 已广泛应用于临床。然而，在全国范围内，MIE 相对于 OE 的明确优势尚未得到确定。
方法
我们使用日本住院患者数据库，分析了 2014 年 4 月至 2017 年 3 月期间接受临床 0 期至 III 期食管癌手术的患者。我们进行了倾向评分匹配，以比较 MIE 和 OE 之间的住院死亡率和并发症发生率，同时考虑到医院内患者的聚类情况。
结果
在 14880 例患者中，倾向评分匹配生成了 4572 对。MIE 与较低的住院死亡率（1.2%比 1.7%，P = 0.048）、手术部位感染（1.9%比 2.6%，P = 0.04）、吻合口漏（12.8%比 16.8%，P < 0.001）、输血（21.9%比 33.8%，P < 0.001）、再次手术（8.6%比 9.9%，P = 0.03）、气管切开术（4.8%比 6.3%，P = 0.002）和计划外插管（6.3%比 8.4%，P < 0.001）相关；术后住院时间更短（23 天比 26 天，P < 0.001）；声带功能障碍发生率更高（9.2%比 7.5%，P < 0.001）和食管癌术后拔管时间延长（23.2%比 19.3%，P < 0.001）；麻醉时间更长（408 分钟比 363 分钟，P < 0.001）。
结论
MIE 在住院死亡率、并发症发生率和术后住院时间方面具有良好的效果。
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