Veenstra M M K, Smithers B M, Visser E, Edholm D, Brosda S, Thomas J M, Gotley D C, Thomson I G, Wijnhoven B P L, Barbour A P
Academy of Surgery, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
BJS Open. 2021 Jan 8;5(1). doi: 10.1093/bjsopen/zraa033.
Minimally invasive oesophagectomy (MIO) is reported to produce fewer respiratory complications than open oesophagectomy. This study assessed differences in postoperative complications between MIO and hybrid MIO (HMIO) employing thoracoscopy and laparotomy, along with the influence of co-morbidities on postoperative outcomes.
Patients with oesophageal cancer undergoing three-stage MIO or three-stage HMIO between 1999 and 2018 were identified from a prospectively developed database, which included patient demographics, co-morbidities, preoperative therapies, and cancer stage. The primary outcome was postoperative complications in the two groups. Secondary outcomes included duration of operation, blood transfusion requirement, duration of hospital stay, and overall survival.
There were 828 patients, of whom 722 had HMIO and 106 MIO, without significant baseline differences. Median duration of operation was longer for MIO (325 versus 289 min; P < 0.001), but with less blood loss (median 250 versus 300 ml; P < 0.001) and a shorter hospital stay (median 12 versus 13 days; P = 0.006). Respiratory complications were not associated with operative approach (31.1 versus 35.2 per cent for MIO and HMIO respectively; P = 0.426). Anastomotic leak rates (10.4 versus 10.2 per cent) and 90-day mortality (1.0 versus 1.7 per cent) did not differ. Cardiac co-morbidity was associated with more medical and surgical complications. Overall survival was associated with AJCC stage and co-morbidities, but not operative approach.
MIO had a small benefit in terms of blood loss and hospital stay, but not in operating time. Oncological outcomes were similar in the two groups. Postoperative complications were associated with pre-existing cardiorespiratory co-morbidities rather than operative approach.
据报道，微创食管切除术（MIO）产生的呼吸道并发症比开放食管切除术少。本研究评估了采用胸腔镜和剖腹术的MIO与杂交微创食管切除术（HMIO）术后并发症的差异，以及合并症对术后结果的影响。
从一个前瞻性建立的数据库中识别出1999年至2018年间接受三阶段MIO或三阶段HMIO的食管癌患者，该数据库包括患者人口统计学、合并症、术前治疗和癌症分期。主要结局是两组的术后并发症。次要结局包括手术时间、输血需求、住院时间和总生存期。
共有828例患者，其中722例行HMIO，106例行MIO，基线无显著差异。MIO的中位手术时间较长（325分钟对289分钟；P<0.001），但失血量较少（中位250毫升对300毫升；P<0.001），住院时间较短（中位12天对13天；P=0.006）。呼吸道并发症与手术方式无关（MIO和HMIO分别为31.1%和35.2%；P=0.426）。吻合口漏发生率（10.4%对10.2%）和90天死亡率（1.0%对1.7%）无差异。心脏合并症与更多的内科和外科并发症相关。总生存期与美国癌症联合委员会（AJCC）分期和合并症有关，但与手术方式无关。
MIO在失血量和住院时间方面有微小益处，但手术时间无差异。两组的肿瘤学结局相似。术后并发症与既往存在的心肺合并症有关，而非手术方式。
