Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA.
Department of Surgery, University of California Irvine Medical Center, 333 City Blvd West, Suite 1600, Orange, CA, 92868, USA.
Surg Endosc. 2020 Jun;34(6):2503-2511. doi: 10.1007/s00464-019-07057-6. Epub 2019 Aug 5.
Initial adoption of minimally invasive esophagectomy (MIE) began in the late 1990s but its surgical technique, perioperative management, and outcome continues to evolve.
The aim of this study was to examine the evolving changes in the technique, outcome, and new strategies in management of postoperative leaks after MIE was performed at a single institution over a two-decade period. A retrospective chart review of 75 MIE operations was performed between November 2011 and September 2018 and this was compared to the initial series of 104 MIE operations performed by the same group between 1998 and 2007. Operative technique, outcomes, and management strategies of leaks were compared.
There were 65 males (86.7%) with an average age of 61 years. The laparoscopic/thoracoscopic Ivor Lewis esophagectomy became the preferred MIE approach (49% of cases in the initial vs. 95% in the current series). Compared to the initial case series, there was no significant difference in median length of stay (8 vs. 8 days), major complications (12.5% vs. 14.7%, p = 0.68), incidence of leak (9.6% vs. 10.6%, p = 0.82), anastomotic stricture (26% vs. 32.0%, p = 0.38), or in-hospital mortality (2.9% vs. 2.6%, p = 0.47). Management of esophageal leaks has changed from primarily thoracotomy ± diversion initially (50% of leak cases) to endoscopic stenting ± laparoscopy/thoracoscopy currently (87.5% of leak cases).
In a single-institutional series of MIE over two decades, there was a shift toward a preference for the laparoscopic/thoracoscopic Ivor Lewis approach with similar outcomes. The management of postoperative leaks drastically changed with predilection toward minimally invasive option with endoscopic drainage and stenting.
微创食管切除术（MIE）始于 20 世纪 90 年代末，但它的手术技术、围手术期管理和结果仍在不断发展。
本研究旨在探讨单一机构在过去 20 年中微创食管切除术后手术技术、结果和术后漏管理新策略的演变。对 2011 年 11 月至 2018 年 9 月期间 75 例 MIE 手术进行回顾性图表分析，并与同一组 1998 年至 2007 年期间进行的 104 例 MIE 手术的初始系列进行比较。比较手术技术、结果和漏的管理策略。
男性 65 例（86.7%），平均年龄 61 岁。腹腔镜/胸腔镜 Ivor Lewis 食管切除术成为首选的 MIE 方法（初始系列中占 49%，当前系列中占 95%）。与初始病例系列相比，中位住院时间（8 天 vs. 8 天）、主要并发症（12.5% vs. 14.7%，p=0.68）、漏的发生率（9.6% vs. 10.6%，p=0.82）、吻合口狭窄（26% vs. 32.0%，p=0.38）或住院死亡率（2.9% vs. 2.6%，p=0.47）均无显著差异。食管漏的治疗方法已从最初的主要开胸手术（50%的漏诊病例）改为目前的内镜支架置入术（±腹腔镜/胸腔镜）（87.5%的漏诊病例）。
在过去 20 年中，单一机构的 MIE 系列中，腹腔镜/胸腔镜 Ivor Lewis 方法的应用逐渐增多，结果相似。术后漏的管理发生了巨大变化，倾向于选择微创内镜引流和支架置入术。
