Chen Xiankai, Luo Peng, Xie Hounai, Yang Yafan, Zhang Ruixiang, Qin Jianjun, Seder Christopher W, Kim Min P, Flores Raja, Xu Lei, Li Yin
Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA.
Ann Transl Med. 2022 Mar;10(6):336. doi: 10.21037/atm-22-1141.
This study aimed to assess the feasibility, efficacy and safety of McKeown surgery with vagal-sparing using minimally invasive esophagectomy (MIE).
McKeown surgery with vagal-sparing technique using MIE was adopted on patients diagnosed with resectable esophageal cancer. From June 2020 to January 2021, a total of 20 patients from the Department of Thoracic Surgery of the National Clinical Research Center for Cancer were enrolled.
The study group included 17 (85%) males and 3 (15%) females, with an average age of 62.6 (±7.1) years. The most common tumor location was lower thoracic esophagus (n=9, 45%), followed by middle thoracic esophagus (n=8, 40%) and upper thoracic esophagus (n=3, 15%). Nine (45%) patients had T1b disease, followed by T2 (n=8, 40%), T1a (n=2, 10%), and Tis (n=1, 5%). The average operation time was 221.5 (±61.2) minutes. Postoperative complications were as follow: 2 (10%) with hoarseness, 2 (10%) with pulmonary infection, 1 (5%) with arrhythmia, 1 (5%) with anastomotic leakage, 1 (5%) with delayed gastric emptying, 1 (5%) with pleural effusion, and 1 (5%) with diarrhea. Dumping syndrome, cholestasis, and chylothorax were not observed, and there was no perioperative death.
MIE with vagus nerve preservation is a feasible and safe technique, with the possibility to be an alternative for esophageal carcinoma. Further study is needed to explore the functional outcome of preserving vagus nerve.
本研究旨在评估采用微创食管切除术（MIE）的保留迷走神经的麦克尤恩手术的可行性、疗效和安全性。
对诊断为可切除食管癌的患者采用MIE的保留迷走神经技术进行麦克尤恩手术。2020年6月至2021年1月，国家癌症临床研究中心胸外科共纳入20例患者。
研究组包括17例（85%）男性和3例（15%）女性，平均年龄62.6（±7.1）岁。最常见的肿瘤部位是胸段食管下段（n = 9，45%），其次是胸段食管中段（n = 8，40%）和胸段食管上段（n = 3，15%）。9例（45%）患者为T1b期疾病，其次是T2期（n = 8，40%）、T1a期（n = 2，10%）和Tis期（n = 1，5%）。平均手术时间为221.5（±61.2）分钟。术后并发症如下：2例（10%）声音嘶哑，2例（10%）肺部感染，1例（5%）心律失常，1例（5%）吻合口漏，1例（5%）胃排空延迟，1例（5%）胸腔积液，1例（5%）腹泻。未观察到倾倒综合征、胆汁淤积和乳糜胸，且无围手术期死亡。
保留迷走神经的MIE是一种可行且安全的技术，有可能成为食管癌的替代治疗方法。需要进一步研究以探索保留迷走神经的功能结果。
