Kilpatrick Fiona, Kanhere Harsh, Stranz Conrad, Prasad Shalvin, Sundararajan Krishnaswamy, Edwards Suzanne, Trochsler Markus, Reddi Benjamin
Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
ANZ J Surg. 2025 Mar;95(3):350-355. doi: 10.1111/ans.19351. Epub 2024 Dec 17.
Oesophagectomy for surgical management of oesophageal carcinoma has previously been performed via an open approach (OE), with a change in recent years to a minimally invasive technique (MIO). We performed a retrospective study to compare the rates of post-operative complications between OE and MIO patients at our institution. Secondary outcomes included nodal yield and ICU LOS.
This is a retrospective, observational, case-matched single centre study of 2-stage oesophagectomies for carcinoma from January 2011 to December 2021. Fourty-four MIO patients were matched by age to 44 OE patients. Post-operative pulmonary, cardiac and surgical complications were defined using the Esophagectomy Complications Consensus Group (ECCG) guidelines.
Baseline characteristics were similar for the two groups, with a higher ASA grade for patients undergoing MIO. There was no significant difference in post-operative pulmonary complication rates between the OE versus MIO groups (41% versus 55%, P = 0.29). There were more cardiac arrhythmias in the MIO group however this was not statistically significant (9.1% versus 22.7%, P = 0.08). Rate of re-operation was equal between the groups with no difference between rates of other surgical complications, ICU LOS or hospital LOS. Significantly higher nodal yield was achieved in the MIO group. Overall rate of Clavien-Dindo graded complications were similar (55% versus 66%, P = 0.28).
MIO was associated with higher lymph node yield, and comparable complication rates when compared to OE and does not significantly alter time spent in hospital.
食管癌的手术治疗以前采用开放手术方式（OE），近年来已转变为微创技术（MIO）。我们进行了一项回顾性研究，以比较我院接受OE和MIO治疗患者的术后并发症发生率。次要结局包括淋巴结清扫数量和重症监护病房住院时间（ICU LOS）。
这是一项回顾性、观察性、病例匹配的单中心研究，研究对象为2011年1月至2021年12月期间因癌症接受两阶段食管切除术的患者。44例接受MIO治疗的患者与44例接受OE治疗的患者按年龄匹配。术后肺部、心脏和手术并发症根据食管切除术后并发症共识组（ECCG）指南进行定义。
两组的基线特征相似，接受MIO治疗的患者美国麻醉医师协会（ASA）分级较高。OE组与MIO组术后肺部并发症发生率无显著差异（41%对55%，P = 0.29）。MIO组心律失常更多，但无统计学意义（9.1%对22.7%，P = 0.08）。两组再次手术率相等，其他手术并发症发生率、ICU住院时间或住院时间无差异。MIO组淋巴结清扫数量显著更高。Clavien-Dindo分级并发症的总体发生率相似（55%对66%，P = 0.28）。
与OE相比，MIO与更高的淋巴结清扫数量相关，并发症发生率相当，且不会显著改变住院时间。
