Naval Medical Center Portsmouth, Portsmouth, VA.
Florida Hospital Cancer Institute, Orlando, FL.
Surgery. 2021 Jul;170(1):263-270. doi: 10.1016/j.surg.2021.02.036. Epub 2021 Apr 22.
Surgical resection has become a mainstay of therapy for locally advanced esophageal cancer and can increase survival significantly. With the advancement of minimally invasive surgery, there is still debate on the best approach for esophagectomy. We report a modern analysis of outcomes with transthoracic versus transhiatal esophagectomy.
A prospectively managed esophagectomy database was queried for patients undergoing transthoracic or transhiatal esophagectomy between 1996 and 2016. Continuous variables were compared using the Kruskal-Wallis or the analysis of variance tests as appropriate. Pearson χ test was used to compare categorical variables. All statistical tests were 2-sided and an α (type I) error < .05 was considered statistically significant.
A total of 846 patients underwent esophagectomy with a median age of 66 (28-86) years. There was no difference in estimated blood loss for transthoracic and transhiatal, but mean operating room times were longer for transthoracic versus transhiatal (P < .001), and the number of retrieved lymph nodes was higher for transthoracic versus transhiatal (P < .002). Postoperative complications occurred in 207 (29%) transthoracic patients vs 59 (44.7%) transhiatal patients, (P < .001). The most common complications in transthoracic versus transhiatal techniques, respectively, were anastomotic leaks: 4.3% vs 9.8%; (P = .01), anastomotic stricture 7% vs 26.5%; (P < .001), and pneumonia 12.6% vs 22.7%; (P < .002). Median survival significantly improved in patients undergoing transthoracic (62 months) vs transhiatal (39 months) P = .03.
We found that a transthoracic approach was associated with lower pneumonias, anastomotic leaks, wound infections, and strictures, with an improvement in nodal harvest. Survival was also significantly improved in patients who underwent transthoracic esophagectomy.
手术切除已成为局部晚期食管癌的主要治疗方法，并能显著提高生存率。随着微创外科的进步，对于食管切除术的最佳方法仍存在争议。我们报告了经胸与经食管裂孔食管切除术的现代结果分析。
对 1996 年至 2016 年间接受经胸或经食管裂孔食管切除术的患者进行前瞻性管理的食管切除术数据库进行了查询。连续变量采用 Kruskal-Wallis 或方差分析检验进行比较。使用 Pearson χ 检验比较分类变量。所有统计检验均为双侧检验，α（Ⅰ型）错误<.05 被认为具有统计学意义。
共 846 例患者接受了食管切除术，中位年龄为 66（28-86）岁。经胸与经食管裂孔手术的估计出血量无差异，但经胸手术的平均手术时间长于经食管裂孔手术（P<.001），经胸手术的淋巴结检出数高于经食管裂孔手术（P<.002）。207 例（29%）经胸患者和 59 例（44.7%）经食管裂孔患者发生术后并发症（P<.001）。经胸与经食管裂孔技术的最常见并发症分别为吻合口漏：4.3% vs 9.8%（P =.01），吻合口狭窄 7% vs 26.5%（P <.001），肺炎 12.6% vs 22.7%（P <.002）。经胸组患者的中位生存时间明显长于经食管裂孔组（62 个月 vs 39 个月，P =.03）。
我们发现经胸入路与较低的肺炎、吻合口漏、伤口感染和狭窄相关，并且淋巴结采集也有所改善。经胸食管切除术患者的生存率也显著提高。
