Department for General and Visceral Surgery, University Hospital Oldenburg, Klinikum Oldenburg AöR, Rahel-Straus-Straße 10, 26133 Oldenburg, Germany.
Medicina (Kaunas). 2023 Feb 22;59(3):434. doi: 10.3390/medicina59030434.
: Though widely used, only limited data is available that shows the superiority of hybrid minimally-invasive esophagectomy (HMIE) compared to open esophagectomy (OE). The present study aimed to analyze postoperative morbidity, mortality, and compare lengths of hospital stay. : A total of 174 patients underwent Ivor Lewis esophagectomy in our surgical department, of which we retrospectively created a matched population of one hundred (HMIE = 50, OE = 50). Morbidity and mortality data was categorized, analyzed, and risk factor analyzed for complications. : The oncological results were found to be comparable in both groups. A median of 23.5 lymphnodes were harvested during OE, and 21.0 during HMIE. Negative tumor margins were achieved in 98% of OE and 100% of HMIE. In-hospital mortality rate showed no significant difference between techniques (OE 14.0%, HMIE 4.0%, = 0.160). Hospital (OE Median 23.00 days, HMIE 16.50 days, = 0.004) and ICU stay (OE 5.50 days, HMIE 3.00 days, = 0.003) was significantly shorter after HMIE. The overall complication rate was 50%, but complications in general (OE 70.00%, HMIE 30%, < 0.001) as well as severe complications (Clavien Dindo ≥ III: HMIE 16.0%, OE 48.0%, < 0.001) were significantly more common after OE. In multivariate stepwise regressions the influence of OE proved to be independent for said outcomes. We observed more pulmonary complications in the OE group (46%) compared to HMIE patients (26%). This difference was statistically significant after adjustment for sex, age, BMI, ASA classification, histology, neoadjuvant treatment or not, smoking status, cardiac comorbidities, diabetes mellitus, and alcohol abuse ( = 0.019). : HMIE is a feasible technique that significantly decreases morbidity, while ensuring equivalently good oncological resection compared to OE. HMIE should be performed whenever applicable for patients and surgeons.
尽管广泛应用，但仅有有限的数据表明，杂交微创食管切除术（HMIE）优于开放食管切除术（OE）。本研究旨在分析术后发病率、死亡率，并比较住院时间。
在我们的外科部门，共有 174 例患者接受了 Ivor Lewis 食管切除术，我们从中回顾性地创建了一个匹配的人群，其中 100 例为 HMIE（HMIE = 50，OE = 50）。对发病率和死亡率数据进行分类、分析，并对并发症的危险因素进行分析。
两组的肿瘤学结果相当。OE 组平均采集 23.5 个淋巴结，HMIE 组采集 21.0 个。OE 组 98%的肿瘤切缘阴性，HMIE 组 100%的肿瘤切缘阴性。两种技术的院内死亡率无显著差异（OE 14.0%，HMIE 4.0%， = 0.160）。HMIE 术后的住院时间（OE 中位数 23.00 天，HMIE 16.50 天， = 0.004）和 ICU 住院时间（OE 5.50 天，HMIE 3.00 天， = 0.003）明显缩短。总并发症发生率为 50%，但 OE 组的一般并发症（OE 70.00%，HMIE 30.00%， < 0.001）和严重并发症（Clavien Dindo ≥ III：HMIE 16.0%，OE 48.0%， < 0.001）明显多于 HMIE 组。多元逐步回归分析表明，OE 的影响是独立的。与 HMIE 患者（26%）相比，OE 组的肺部并发症（46%）更多。在调整性别、年龄、BMI、ASA 分类、组织学、新辅助治疗、吸烟状况、心脏合并症、糖尿病和酒精滥用等因素后，这一差异具有统计学意义（ = 0.019）。
HMIE 是一种可行的技术，与 OE 相比，它能显著降低发病率，同时确保同样良好的肿瘤切除效果。HMIE 应在适当时为患者和外科医生进行。
