Klevebro F, Han S, Ash S, Mueller C, Cools-Lartigue J, Maynard N, Ferri L, Low D
Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle WA, USA.
Department of Surgery, CLINTEC Karolinska Institutet, Stockholm, Sweden.
Dis Esophagus. 2022 Dec 31;36(1). doi: 10.1093/dote/doac024.
Minimally invasive surgical technique has become standard at many institutions in esophageal cancer surgery. In some situations, however other surgical approaches are required. Left thoracoabdominal esophagectomy (LTE) facilitates complete resection of esophageal cancer particularly for bulky distal esophageal tumors, but there are concerns that this approach is associated with significant morbidity. Prospectively entered esophagectomy databases from three high-volume centers were reviewed for patients undergoing LTE or MIE 2009-2019. Patient demographics, tumor characteristics, operative outcomes, postoperative outcomes, and pathologic surrogates of oncologic efficacy (R0 resection rate, and number of resected lymph nodes) were compared. In total 915 patients were included in the study, LTE was applied in 684 (74.8%) patients, and MIE in 231 (25.2%) patients. LTE patients had more locally advanced tumor stage and received more neoadjuvant treatment. Patients treated with MIE had more comorbidities. The results showed no difference in overall postoperative complications (LTE = 61.7%, MIE = 65.7%, P = 0.289), severe complications (Clavien-Dindo ≥IIIa (LTE = 25.9%, MIE 26.8%, P = 0.806)), pneumonia (LTE = 29.0%, MIE = 24.7%, P = 0.211), anastomotic leak (LTE = 7.8%, MIE = 11.3%, P = 0.101), or in-hospital mortality (LTE = 2.6%, MIE = 3.5%, P = 0.511). Median number of resected lymph nodes was 24 for LTE and 25 for MIE (P = 0.491). LTE was used for more advanced tumors in patients that were more likely to have received neoadjuvant treatment compared with MIE, however postoperative morbidity, mortality, and oncologic outcomes were equivalent to that of MIE in this cohort. In conclusion open resection with left thoracoabdominal approach is a valid option in selected patients when performed at high-volume esophagectomy centers.
微创外科技术已成为许多机构食管癌手术的标准术式。然而，在某些情况下，需要采用其他手术方法。左胸腹联合食管癌切除术（LTE）有助于完全切除食管癌，特别是对于体积较大的远端食管肿瘤，但有人担心这种方法会导致较高的并发症发生率。回顾了来自三个高容量中心的前瞻性食管癌切除术数据库中2009年至2019年接受LTE或MIE的患者。比较了患者的人口统计学特征、肿瘤特征、手术结果、术后结果以及肿瘤疗效的病理替代指标（R0切除率和切除淋巴结数量）。该研究共纳入915例患者，其中684例（74.8%）应用了LTE，231例（25.2%）应用了MIE。LTE组患者的肿瘤分期更晚，接受新辅助治疗的比例更高。接受MIE治疗的患者合并症更多。结果显示，总体术后并发症（LTE=61.7%，MIE=65.7%，P=0.289）、严重并发症（Clavien-Dindo≥IIIa级，LTE=25.9%，MIE=26.8%，P=0.806）、肺炎（LTE=29.0%，MIE=24.7%，P=0.211）、吻合口漏（LTE=7.8%，MIE=11.3%，P=0.101）或住院死亡率（LTE=2.6%，MIE=3.5%，P=0.511）方面均无差异。LTE组和MIE组切除淋巴结的中位数分别为24个和25个（P=0.491）。与MIE相比，LTE用于更可能接受新辅助治疗的更晚期肿瘤患者，但该队列中LTE的术后发病率、死亡率和肿瘤学结果与MIE相当。总之，如果在高容量食管癌切除中心进行手术，对于选定的患者，左胸腹联合开放切除术是一种有效的选择。
