Aslan Sezer, Tiryaki Gamze Gul, Pashayev Jeyhun, Cetinkaya Cagatay, Durusoy Ali Fuad, Ermerak Nezih Onur, Batirel Hasan Fevzi
Department of Thoracic Surgery, Sirnak State Hospital, Sirnak, Turkey.
Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul, Turkey.
Interdiscip Cardiovasc Thorac Surg. 2023 May 4;36(5). doi: 10.1093/icvts/ivad034.
Minimally invasive esophagectomy has improved over time becoming faster and less invasive. We have changed our technical approach from multiportal to uniportal video-assisted thoracoscopic surgery (VATS) esophagectomy over the years. In this study, we analysed our results with uniportal VATS esophagectomy technique.
This study was a retrospective analysis of 40 consecutive patients with the intent to perform uniportal VATS esophagectomy for esophageal cancer between July 2017 and August 2021. Demographic criteria, comorbidities, neoadjuvant therapy, intraoperative data, complications, length of stay, pathological data, 30- and 90-day mortality and 2-year survival data were recorded.
Forty patients (21 female) were operated (median age 62.9 [53.5-70.25]). Eighteen patients (45%) received neoadjuvant chemoradiation. The chest part of all cases was started with uniportal VATS and 31 (77.5%) was completed uniportally (34 Ivor Lewis, 6 McKeown). The median thoracic operation time in minimally invasive Ivor Lewis esophagectomy was 90 min (77.5-100). The median time for uniportal side-to-side anastomosis was 12 min (11-16). Five (12.5%) patients had leak, and 4 were intrathoracic. Twenty-eight (70%) patients had squamous cell carcinoma, 11 adenocarcinoma and 1 squamous cell carcinoma with sarcomatoid differentiation. Thirty-seven (92.5%) patients had R0 resection. The mean number of lymph nodes dissected was 24 ± 9.5. Thirty- and ninety-day mortality was 2.5% (n = 1). The mean follow-up was 44 ± 2.8 months. Two-year survival was 80%.
Uniportal VATS esophagectomy is a safe, fast and feasible alternative to other minimally invasive and open approaches. Comparable results to contemporary series are observed in perioperative and oncologic outcomes.
随着时间的推移，微创食管切除术有了改进，手术速度更快，创伤更小。多年来，我们已将技术方法从多端口改为单端口电视辅助胸腔镜手术（VATS）食管切除术。在本研究中，我们分析了采用单端口VATS食管切除术技术的结果。
本研究是一项对2017年7月至2021年8月期间连续40例拟行单端口VATS食管癌切除术患者的回顾性分析。记录人口统计学标准、合并症、新辅助治疗、术中数据、并发症、住院时间、病理数据、30天和90天死亡率以及2年生存数据。
40例患者（21例女性）接受了手术（中位年龄62.9岁[53.5 - 70.25岁]）。18例患者（45%）接受了新辅助放化疗。所有病例的胸部手术均以单端口VATS开始，31例（77.5%）通过单端口完成（34例采用Ivor Lewis术式，6例采用McKeown术式）。微创Ivor Lewis食管切除术中胸腔手术的中位时间为90分钟（77.5 - 100分钟）。单端口侧侧吻合的中位时间为12分钟（11 - 16分钟）。5例（12.5%）患者发生渗漏，4例为胸腔内渗漏。28例（70%）患者为鳞状细胞癌，11例为腺癌，1例为伴有肉瘤样分化的鳞状细胞癌。37例（92.5%）患者实现了R0切除。平均清扫淋巴结数量为24 ± 9.5个。30天和90天死亡率为2.5%（n = 1）。平均随访时间为44 ± 2.8个月。2年生存率为80%。
单端口VATS食管切除术是其他微创和开放手术方法的一种安全、快速且可行的替代方案。在围手术期和肿瘤学结果方面，观察到与当代系列研究相当的结果。
