Department of Thoracic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou City, Zhejiang Province, China.
BMC Cancer. 2024 Sep 5;24(1):1104. doi: 10.1186/s12885-024-12754-0.
The purpose of this retrospective study was to compare the safety and feasibility of single-intercostal totally minimally invasive Ivor Lewis esophagectomy (MIIE) with those of multiple-intercostal MIIE.
Between January 2016 and December 2022, clinical data were collected for 528 patients who successfully underwent totally minimally invasive esophagectomy. Among these patients, 294 underwent MIIE, with 200 undergoing the single-intercostal approach and 94 undergoing the multiple-intercostal approach. Propensity score matching (PSM) was applied to the cohort of 294 patients. Subsequently, perioperative outcomes and other pertinent clinical data were analyzed retrospectively.
A total of 294 patients were subjected to PSM, and 89 groups of patient data (178 persons in total) were well balanced and included in the follow-up statistics. Compared to the multiple intercostal group, the single intercostal group had a shorter operative time (280 min vs. 310 min; p < 0.05). Moreover, there was no significant difference in the incidence of major perioperative complications (p > 0.05). The total number of lymph nodes sampled (25.30 vs. 27.55, p > 0.05) and recurrent laryngeal nerve lymph nodes sampled on the both sides (p > 0.05) did not significantly differ. The single intercostal group had lower postoperative long-term usage of morphine (0,0-60 vs. 20,20-130; p < 0.01), total temporary addition (10,0-30 vs. 20,20-40; p < 0.01) and temporary usage in the first 3 days after surgery (0,0-15 vs. 10,10-20; p < 0.01) than did the multicostal group.There were no significant differences in age, sex, tumor location or extent of lymphadenectomy or in the clinical factors between the single-intercostal group (p > 0.05).
Both techniques can be used for the treatment of esophageal cancer. Compared to multiple intercostal MIIE, the feasibility of which has been proven internationally, the single intercostal technique can also be applied to patients of different age groups and sexes and with different tumor locations. It can provide surgeons with an additional surgical option.
This study was retrospectively registered by the Ethics Committee of the Second Affiliated Hospital of Zhejiang University School of Medicine, and written informed consent was exempted from ethical review. The registration number was 20,230,326. The date of registration was 2023.03.26.
本回顾性研究旨在比较单肋间完全微创 Ivor Lewis 食管切除术（MIIE）与多肋间 MIIE 的安全性和可行性。
2016 年 1 月至 2022 年 12 月，共收集了 528 例成功接受完全微创食管切除术的患者的临床资料。其中 294 例患者接受 MIIE，200 例采用单肋间入路，94 例采用多肋间入路。对 294 例患者进行倾向评分匹配（PSM）。随后，回顾性分析围手术期结果和其他相关临床数据。
共对 294 例患者进行 PSM，89 组患者数据（共 178 人）均衡，纳入随访统计。与多肋间组相比，单肋间组的手术时间更短（280 分钟 vs. 310 分钟；p<0.05）。此外，两组主要围手术期并发症的发生率无显著差异（p>0.05）。两组淋巴结清扫总数（25.30 个 vs. 27.55 个，p>0.05）和双侧喉返神经淋巴结清扫数（p>0.05）无显著差异。与多肋间组相比，单肋间组术后吗啡的长期使用量（0、0-60 比 20、20-130；p<0.01）、总临时添加量（10、0-30 比 20、20-40；p<0.01）和术后 3 天内临时使用量（0、0-15 比 10、10-20；p<0.01）均较低。单肋间组与多肋间组患者的年龄、性别、肿瘤位置或淋巴结清扫范围或临床因素无显著差异（p>0.05）。
两种技术均可用于治疗食管癌。与已被国际证明可行的多肋间 MIIE 相比，单肋间技术也可应用于不同年龄、性别和肿瘤位置的患者，可为外科医生提供另一种手术选择。
本研究由浙江大学医学院第二附属医院伦理委员会进行回顾性注册，豁免伦理审查。注册号为 20,230,326。注册日期为 2023.03.26。
