Chowdappa Ramachandra, Dharanikota Anvesh, Arjunan Ravi, Althaf Syed, Premalata Chennagiri S, Ranganath Namrata
Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India.
Department of Pathology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India.
South Asian J Cancer. 2021 Dec 31;10(4):230-235. doi: 10.1055/s-0041-1730085. eCollection 2021 Dec.
There is a recent rise in the incidence of esophageal carcinoma in India. Surgical resection with or without neoadjuvant chemoradiation is the current treatment modality of choice. Postoperative complications, especially pulmonary complications, affect many patients who undergo open esophagectomy for esophageal cancer. Minimally invasive esophagectomy (MIE) could reduce the pulmonary complications and reduce the postoperative stay. We performed a retrospective analysis of prospectively collected data of 114 patients with esophageal cancer in the department of surgical oncology at a tertiary cancer center in South India between January 2019 and March 2020. We included patients with resectable cancer of middle or lower third of the esophagus, and gastroesophageal junction tumors (Siewert I). MIE was performed in 27 patients and 78 patients underwent open esophagectomy (OE). The primary outcome measured was postoperative complications of Clavien-Dindo grade II or higher within 30 days. Other outcomes measured include overall mortality within 30 days, intraoperative complications, operative duration and the length of hospital stay. A postoperative complication rate of 18.5% was noted in the MIE group, compared with 41% in the OE group ( = 0.034). Pulmonary complications were noted in 7.4% in the MIE group compared to 25.6% in the OE group ( = 0.044). Postoperative mortality rates, intraoperative complications, and other nonpulmonary postoperative complications were almost similar with MIE as with open esophagectomy. Although the median operative time was more in the MIE group (260 minutes vs. 180 minutes; < 0.0001), the median length of hospital stay was shorter in patients undergoing MIE (9 days vs. 12 days; = 0.0001). We found that MIE resulted in lower incidence of postoperative complications, especially pulmonary complications. Although, MIE was associated with prolonged operative duration, it resulted in shorter hospital stay.
印度食管癌的发病率近期有所上升。手术切除联合或不联合新辅助放化疗是目前的首选治疗方式。术后并发症，尤其是肺部并发症，影响着许多接受食管癌开放食管切除术的患者。微创食管切除术（MIE）可减少肺部并发症并缩短术后住院时间。我们对印度南部一家三级癌症中心外科肿瘤学部门2019年1月至2020年3月期间前瞻性收集的114例食管癌患者的数据进行了回顾性分析。我们纳入了食管中下段可切除癌患者以及胃食管交界部肿瘤（Siewert I型）患者。27例患者接受了MIE，78例患者接受了开放食管切除术（OE）。主要观察指标为30天内Clavien-Dindo II级或更高等级的术后并发症。其他观察指标包括30天内的总体死亡率、术中并发症、手术时长和住院时间。MIE组术后并发症发生率为18.5%，而OE组为41%（P = 0.034）。MIE组肺部并发症发生率为7.4%，而OE组为25.6%（P = 0.044）。MIE组的术后死亡率、术中并发症以及其他非肺部术后并发症与开放食管切除术组几乎相似。虽然MIE组的中位手术时间更长（260分钟对180分钟；P < 0.0001），但接受MIE的患者中位住院时间更短（9天对12天；P = 0.0001）。我们发现MIE导致术后并发症发生率更低，尤其是肺部并发症。虽然MIE与手术时间延长有关，但它导致住院时间缩短。
