与开放性食管癌切除术相比，微创食管癌切除术后的手术并发症：芬兰一项基于人群的全国性研究。

Surgical complications after minimally invasive oesophagectomy compared to open oesophagectomy for oesophageal cancer: A population-based, nationwide study in Finland.

作者信息

Sirviö Ville E J, Räsänen Jari V, Helminen Olli, Helmiö Mika, Huhta Heikki, Kallio Raija, Koivukangas Vesa, Kokkola Arto, Lietzen Elina, Meriläinen Sanna, Pohjanen Vesa-Matti, Rantanen Tuomo, Ristimäki Ari, Saarnio Juha, Sihvo Eero, Tyrväinen Tuula, Uimonen Mikko, Valtola Antti, Kauppila Joonas H

机构信息

Department of Oesophageal and General Thoracic Surgery, Helsinki University Hospital and University of Helsinki, Finland.

出版信息

Eur J Surg Oncol. 2025 Jul;51(7):110093. doi: 10.1016/j.ejso.2025.110093. Epub 2025 Apr 23.

DOI:10.1016/j.ejso.2025.110093

PMID:40373556

Abstract

INTRODUCTION

Evidence on the safety of minimally invasive oesophagectomy (MIO) compared to open oesophagectomy (OO) in nationwide practice is lacking. The aim of this study was to compare surgical complications after MIO and OO in a nationwide, population-based, unselected cohort.

MATERIALS AND METHODS

Descriptive statistics were used to report complications and complication categories defined by the Oesophagectomy Complications Consensus Group, major complications, reoperations and 90-day mortality in all patients undergoing MIO and OO in Finland during 2007-2016. Main outcomes were compared using logistic regression, adjusting for confounding.

RESULTS

Out of 699 patients, 295 (42 %) underwent MIO and 404 (58 %) underwent OO. Rates of anastomotic leakage (10 % vs 14 %, OR 0.47 (0.25-0.89)), intrathoracic abscesses (3 % vs 9 %, OR 0.13 (0.05-0.46)), major complications (35 % vs 47 %, OR 0.39 (0.25-0.60)) and reoperations (18 % vs 26 %, OR 0.43 (0.26-0.73)) were lower with MIO. Rates of pneumonia (16 % vs 27 %, OR 0.62 (0.38-1.03)), intra-abdominal abscesses (0.7 % vs 3.0 %, OR 0.20 (0.04-1.13)) and 90-day mortality (3.1 % vs 6.7 %, HR 0.48 (0.18-1.26)) were lower with MIO, but non-significant after adjustment. Pulmonary complications (36 % vs 46 %, OR 0.63 (0.41-0.96)) and infectious complications (11 % vs 22 %, OR 0.41 (0.23-0.73)) were less common with MIO, while rates of cardiac, gastrointestinal, urologic, thromboembolic, and neurologic complications were similar.

CONCLUSION

This study suggests a significant reduction in various surgical complications in patients undergoing MIO compared to OO and that implementing MIO into nationwide practice can be done safely.

摘要

引言

在全国范围内的实际应用中，缺乏与开放食管切除术（OO）相比，微创食管切除术（MIO）安全性的相关证据。本研究的目的是在全国范围内、基于人群的非选择性队列中比较MIO和OO术后的手术并发症。

材料与方法

采用描述性统计方法报告2007年至2016年期间在芬兰接受MIO和OO的所有患者的并发症及由食管切除术并发症共识小组定义的并发症类别、主要并发症、再次手术和90天死亡率。使用逻辑回归比较主要结局，并对混杂因素进行调整。

结果

699例患者中，295例（42%）接受了MIO，404例（58%）接受了OO。MIO组的吻合口漏发生率（10%对14%，比值比0.47（0.25 - 0.89））、胸腔内脓肿发生率（3%对9%，比值比0.13（0.05 - 0.46））、主要并发症发生率（35%对47%，比值比0.39（0.25 - 0.60））和再次手术率（18%对26%，比值比0.43（0.26 - 0.73））较低。MIO组的肺炎发生率（16%对27%，比值比0.62（0.38 - 1.03））、腹腔内脓肿发生率（0.7%对3.0%，比值比0.20（0.04 - 1.13））和90天死亡率（3.1%对6.7%，风险比0.48（0.18 - 1.26））较低，但调整后无统计学意义。MIO组的肺部并发症（36%对46%，比值比0.63（0.41 - 0.96））和感染性并发症（11%对22%，比值比0.41（0.23 - 0.73））较少见，而心脏、胃肠道、泌尿、血栓栓塞和神经并发症的发生率相似。