Ozawa Soji, Koyanagi Kazuo, Ninomiya Yamato, Yatabe Kentaro, Higuchi Tadashi
Department of Gastroenterological Surgery Tokai University School of Medicine Kanagawa Japan.
Ann Gastroenterol Surg. 2020 Feb 12;4(2):126-134. doi: 10.1002/ags3.12315. eCollection 2020 Mar.
Minimally invasive esophagectomy (MIE) has been performed increasingly more frequently for the treatment of esophageal cancer, ever since it was first described in 1992. However, the incidence of postoperative complications of MIE has not yet been well-characterized, because (a) there are few reports of studies with a sufficient sample size, (b) a variety of minimally invasive surgical techniques are used, and (c) there are few reports in which an established system for classifying the severity of complications is examined. According to an analysis performed by the Esophageal Complications Consensus Group, the most common complications of MIE are pneumonia, arrhythmia, anastomotic leakage, conduit necrosis, chylothorax, and recurrent laryngeal nerve palsy. Therefore, we decided to focus on these complications. We selected 48 out of 1245 reports of studies (a) that included more than 50 patients each, (b) in which the esophagectomy technique used was clearly described, and (c) in which the complications were adequately described. The overall incidences of the postoperative complications of MIE for esophageal cancer were analyzed according to the MIE technique adopted, that is, McKeown MIE, Ivor Lewis MIE, robotic-assisted McKeown MIE, robotic-assisted Ivor Lewis MIE, or mediastinoscopic transmediastinal esophagectomy. Pneumonia, arrhythmia, anastomotic leakage, and recurrent laryngeal nerve palsy occurred at an incidence rate of about 10% each; Ivor Lewis MIE was associated with a relatively low incidence of recurrent laryngeal nerve palsy. It is important to recognize that the incidences of complications of MIE are influenced by the MIE technique adopted and the extent of lymph node dissection.
自1992年首次被描述以来，微创食管切除术（MIE）在食管癌治疗中的应用越来越频繁。然而，MIE术后并发症的发生率尚未得到充分描述，原因如下：（a）样本量充足的研究报告较少；（b）使用了多种微创外科技术；（c）很少有报告对已建立的并发症严重程度分类系统进行研究。根据食管并发症共识小组的分析，MIE最常见的并发症是肺炎、心律失常、吻合口漏、管道坏死、乳糜胸和喉返神经麻痹。因此，我们决定关注这些并发症。我们从1245篇研究报告中筛选出48篇，这些报告需满足以下条件：（a）每项研究纳入的患者超过50例；（b）明确描述了所采用的食管切除技术；（c）对并发症进行了充分描述。根据所采用的MIE技术，即麦克尤恩MIE、艾弗·刘易斯MIE、机器人辅助麦克尤恩MIE、机器人辅助艾弗·刘易斯MIE或纵隔镜经纵隔食管切除术，分析了MIE治疗食管癌术后并发症的总体发生率。肺炎、心律失常、吻合口漏和喉返神经麻痹的发生率均约为10%；艾弗·刘易斯MIE的喉返神经麻痹发生率相对较低。必须认识到，MIE并发症的发生率受所采用的MIE技术和淋巴结清扫范围的影响。
