University of South Florida Morsani College of Medicine, Tampa, FL, USA.
Department of Surgery, Division of Gastrointestinal Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA.
Surg Endosc. 2022 Mar;36(3):1887-1893. doi: 10.1007/s00464-021-08468-0. Epub 2021 Apr 6.
We report mortality and post-operative complications from esophageal resection in the treatment of gastroesophageal adenocarcinoma or stricture, comparing a minimally invasive abdomen-only esophagectomy (MIAE) approach with a minimally invasive Ivor Lewis esophagectomy (MIILE) approach.
A single-center retrospective cohort study of patients with esophageal adenocarcinoma or stricture treated by either MIAE or MIILE was conducted. MIAE was offered for strictures less than five centimeters or cancers that were American Joint Committee on Cancer (AJCC) Stage ≤ T2 without lymphadenopathy. Patients treated with these surgical techniques were analyzed to assess pre-operative risk, intra and post-operative variables, adverse events, and overall survival.
This study included 17 patients undergoing MIAE and 32 patients treated with MIILE. There were a fewer median number of lymph nodes resected (p < 0.001) and shorter operative duration (p < 0.001) for MIAE compared to MIILE. MIAE patients also had significantly higher Charlson Comorbidity Index scores and ACS National Surgical Quality Improvement Program (NSQIP) surgical risk values than MIILE patients (p < 0.05). There was no difference in median estimated blood loss, length of stay, pulmonary or cardiac complications between groups. There was no significant difference in 90-day survival.
A minimally invasive abdomen-only approach in a specific patient population is comparable in safety to a minimally invasive Ivor Lewis approach, with associated shorter median operative duration. MIAE patients had significantly greater pre-operative comorbidities and higher calculated peri-operative risk of complication but demonstrated similar post-operative outcomes. This suggests that MIAE may be a suitable surgical approach for treating gastroesophageal adenocarcinoma or stricture in patients deemed unsuitable for MIILE.
我们报告了胃食管腺癌或狭窄患者行食管切除术的死亡率和术后并发症，比较了微创经腹-only 食管切除术（MIAE）和微创 Ivor Lewis 食管切除术（MIILE）两种方法。
对接受 MIAE 或 MIILE 治疗的食管腺癌或狭窄患者进行了单中心回顾性队列研究。MIAE 适用于小于 5 厘米的狭窄或 AJCC 分期≤T2 且无淋巴结转移的癌症。分析接受这些手术技术治疗的患者，以评估术前风险、围手术期变量、不良事件和总生存率。
本研究纳入了 17 例行 MIAE 手术和 32 例行 MIILE 手术的患者。与 MIILE 相比，MIAE 组的淋巴结切除中位数较少（p<0.001），手术时间更短（p<0.001）。MIAE 患者的 Charlson 合并症指数评分和 ACS 国家手术质量改进计划（NSQIP）手术风险值也显著高于 MIILE 患者（p<0.05）。两组间的中位估计出血量、住院时间、肺部或心脏并发症无差异。90 天生存率无差异。
在特定患者人群中，微创经腹-only 方法在安全性方面与微创 Ivor Lewis 方法相当，中位手术时间更短。MIAE 患者术前合并症明显更多，围手术期并发症的计算风险更高，但术后结果相似。这表明，对于不适合 MIILE 的患者，MIAE 可能是治疗胃食管腺癌或狭窄的一种合适的手术方法。
