Esophageal resection is associated with a high morbidity and mortality rate. Minimally invasive esophagectomy (MIE) might theoretically decrease this rate. We reviewed the current literature on MIE, with a focus on th...Esophageal resection is associated with a high morbidity and mortality rate. Minimally invasive esophagectomy (MIE) might theoretically decrease this rate. We reviewed the current literature on MIE, with a focus on the available techniques, outcomes and comparison with open surgery. This review shows that the available literature on MIE is still crowded with heterogeneous studies with different techniques. There are no controlled and randomized trials, and the few retrospective comparative cohort studies are limited by small numbers of patients and biased by historical controls of open surgery. Based on the available literature, there is no evidence that MIE brings clear benef its compared to conventional esophagectomy. Increasing experience and the report of larger series might change this scenario.展开更多
目的对比两种微创食管切除术(minimally invasive esophagectomy,MIE)治疗T3期中下段食管癌的疗效。方法回顾性分析食管癌数据库中2010年1月-2017年6月在国内十家医院接受MIE治疗且术后病理证实为T3期的食管癌患者资料。比较接受微创Ivo...目的对比两种微创食管切除术(minimally invasive esophagectomy,MIE)治疗T3期中下段食管癌的疗效。方法回顾性分析食管癌数据库中2010年1月-2017年6月在国内十家医院接受MIE治疗且术后病理证实为T3期的食管癌患者资料。比较接受微创Ivor-Lewis术式(MIE-IL)与McKeown术式(MIE-MK)患者的围术期指标、术后并发症、病理指标及术后生存率。结果接受MIE-IL和MIE-MK的患者分别为338例和622例,两组患者中均以男性居多(87.0% vs 77.5%,P<0.001)。肿瘤位置主要位于胸中段(78.7% vs 84.4%,P=0.021),病理类型以鳞癌为主(97.3% vs 98.2%,P=0.659)。MIE-IL和MIE-MK组手术时间[(341.2±97.2) min vs (317.8±93.0) min,P<0.001]、术中出血量[(489.9±511.24) ml vs (364.3±428.9) ml,P<0.001]、淋巴结清扫数量[(14.9±9.23) vs (22.3±11.9),P<0.001]差异有统计学意义。两组术后住院时间[(18.5±11.6) d vs(18.8±12.8) d]差异无统计学意义,术后并发症MIE-IL组明显少于MIE-MK组,尤其在肺部炎症(9.5% vs 20.9%,P<0.001)、胸腔积液(12.7% vs 18.8%,P=0.016)方面,但是在吻合口漏(3.8% vs 6.1%)及吻合口狭窄(0.3% vs 0.3%)方面差异无统计学意义。MIE-IL组总体生存率要低于MIE-MK组(38.6% vs 61.4%;HR:1.49,95% CI:1.19 ~ 1.87;P<0.001)。结论本研究初步显示,两种术式治疗T3期食管癌均安全可行,MIE-IL组术后并发症发生率低于MIE-MK组,但MIE-MK组有更好的远期效果。展开更多
文摘Esophageal resection is associated with a high morbidity and mortality rate. Minimally invasive esophagectomy (MIE) might theoretically decrease this rate. We reviewed the current literature on MIE, with a focus on the available techniques, outcomes and comparison with open surgery. This review shows that the available literature on MIE is still crowded with heterogeneous studies with different techniques. There are no controlled and randomized trials, and the few retrospective comparative cohort studies are limited by small numbers of patients and biased by historical controls of open surgery. Based on the available literature, there is no evidence that MIE brings clear benef its compared to conventional esophagectomy. Increasing experience and the report of larger series might change this scenario.
文摘目的对比两种微创食管切除术(minimally invasive esophagectomy,MIE)治疗T3期中下段食管癌的疗效。方法回顾性分析食管癌数据库中2010年1月-2017年6月在国内十家医院接受MIE治疗且术后病理证实为T3期的食管癌患者资料。比较接受微创Ivor-Lewis术式(MIE-IL)与McKeown术式(MIE-MK)患者的围术期指标、术后并发症、病理指标及术后生存率。结果接受MIE-IL和MIE-MK的患者分别为338例和622例,两组患者中均以男性居多(87.0% vs 77.5%,P<0.001)。肿瘤位置主要位于胸中段(78.7% vs 84.4%,P=0.021),病理类型以鳞癌为主(97.3% vs 98.2%,P=0.659)。MIE-IL和MIE-MK组手术时间[(341.2±97.2) min vs (317.8±93.0) min,P<0.001]、术中出血量[(489.9±511.24) ml vs (364.3±428.9) ml,P<0.001]、淋巴结清扫数量[(14.9±9.23) vs (22.3±11.9),P<0.001]差异有统计学意义。两组术后住院时间[(18.5±11.6) d vs(18.8±12.8) d]差异无统计学意义,术后并发症MIE-IL组明显少于MIE-MK组,尤其在肺部炎症(9.5% vs 20.9%,P<0.001)、胸腔积液(12.7% vs 18.8%,P=0.016)方面,但是在吻合口漏(3.8% vs 6.1%)及吻合口狭窄(0.3% vs 0.3%)方面差异无统计学意义。MIE-IL组总体生存率要低于MIE-MK组(38.6% vs 61.4%;HR:1.49,95% CI:1.19 ~ 1.87;P<0.001)。结论本研究初步显示,两种术式治疗T3期食管癌均安全可行,MIE-IL组术后并发症发生率低于MIE-MK组,但MIE-MK组有更好的远期效果。
