Yin Zhe, Yang Ren-Mei, Jiang Yue-Quan, Chen Qi, Cai Hua-Rong
Department of Thoracic Surgery, Chongqing University Cancer Hospital, Chongqing Cancer Hospital, Chongqing, 400030, People's Republic of China.
Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing Cancer Hospital, Chongqing, 400030, People's Republic of China.
Int J Gen Med. 2022 Mar 29;15:3393-3404. doi: 10.2147/IJGM.S347230. eCollection 2022.
This study assessed the efficacy of transcervical and transhiatal esophagectomy versus thoracoscopic esophagectomy in patients with esophageal carcinoma (EC).
A total of 80 patients with EC were enrolled in this study, including 40 cases in the observation group that received transcervical combine transhiatal esophagectomy and the rest 40 cases of the group that underwent thoracoscopic esophagectomy. The preoperative, intraoperative, and postoperative data were analyzed between the two surgeries, regarding perioperative bleeding, the total number of dissected mediastinal lymph nodes, operative time, number of lymph nodes in the left para-recurrent laryngeal nerve (para-RLN) or the right para-RLN, time in the intensive care unit (ICU), postoperative pain score, the length of postoperative stay (LOPS), PO/fraction of inspired oxygen (PO/FiO2), pulmonary infection, and lymphatic metastasis.
The operations were successfully performed in all 80 patients. The results showed that patients who underwent transcervical and transhiatal esophagectomy had shorter operations than those with transthoracic esophagectomy (200 minutes vs 235 minutes, Kruskal-Wallis test [] = -3.700, < 0.001). The number of dissected mediastinal lymph nodes in the left para-RLN in the observation group was higher than in the control group (25.0% vs 2.5%, = 2.568, = 0.010). The postoperative pain score day 1 (0.0% vs 17.5%, = -4.292, < 0.001), postoperative pain score day 3 (12.5% vs 37.5%, = -3.363, < 0.001) and 48-h PO/FiO2 (290 minutes vs 255 minutes, = 3.747, < 0.001) were significant between the two groups. The LOPS of patients with EC in the observation group was shorter than the control group (7 vs 8, = -2.119, = 0.034). The number of patients receiving transcervical and transhiatal esophagectomy that developed postoperative pulmonary infections was less than the controls (chi-square [ ] = 4.114, = 0.043). Moreover, the transcervical and transhiatal esophagectomy was an independent protect factor for postoperative pulmonary infection (odds ratio [OR] =7.801, P = 0.037).
The transcervical and transhiatal esophagectomy is a good operation for treating patients with EC, which may offer an opportunity to treat cases who cannot have thoracotomy.
本研究评估了经颈经裂孔食管切除术与胸腔镜食管切除术治疗食管癌（EC）患者的疗效。
本研究共纳入80例EC患者，其中观察组40例接受经颈联合经裂孔食管切除术，其余40例接受胸腔镜食管切除术。分析两种手术的术前、术中和术后数据，包括围手术期出血、纵隔淋巴结清扫总数、手术时间、左或右喉返神经旁淋巴结数量、重症监护病房（ICU）停留时间、术后疼痛评分、术后住院时间（LOPS）、动脉血氧分压/吸入氧分数（PO/FiO2）、肺部感染和淋巴转移情况。
80例患者均手术成功。结果显示，接受经颈经裂孔食管切除术的患者手术时间比开胸食管切除术患者短（200分钟对235分钟，Kruskal-Wallis检验[]=-3.700，<0.001）。观察组左喉返神经旁纵隔淋巴结清扫数量高于对照组（25.0%对2.5%，=2.568，=0.010）。两组术后第1天疼痛评分（0.0%对17.5%，=-4.292，< 0.001）、术后第3天疼痛评分（12.5%对37.5%，=-3.363，<0.001）和48小时PO/FiO2（290分钟对255分钟，=3.747，<0.001）差异有统计学意义。观察组EC患者的LOPS短于对照组（7天对8天，=-2.119，=0.034）。接受经颈经裂孔食管切除术的患者术后发生肺部感染的人数少于对照组（卡方[]=4.114，=0.043）。此外，经颈经裂孔食管切除术是术后肺部感染的独立保护因素（比值比[OR]=7.801，P=0.037）。
经颈经裂孔食管切除术是治疗EC患者的一种良好手术方式，可为无法进行开胸手术的患者提供治疗机会。
