Comparison of Short-Term Outcomes Between Open and Minimally Invasive Esophagectomy for Esophageal Cancer Using a Nationwide Database in Japan
Comparison of Short-Term Outcomes Between Open and Minimally Invasive Esophagectomy for Esophageal Cancer Using a Nationwide Database in Japan
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DOI：
10.1245/s10434-017-5808-4
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发表时间：
2017-07-01
影响因子：
3.7
通讯作者：
Kitagawa, Yuko
中科院分区：
文献类型：
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作者：
Takeuchi, Hiroya;Miyata, Hiroaki;Kitagawa, Yuko
本研究旨在使用日本全国性数据库比较微创食管切除术（MIE）与开放食管切除术（OE）治疗胸段食管癌的短期结局，对2011-2012年在864家医院接受食管切除术的9584例胸段食管癌患者进行了评价。我们根据每个患者的估计倾向评分在MIE和OE组之间进行一对一匹配，倾向评分匹配后，MIE组的手术时间明显较长（n = 3515）比OE组（n = 3515）[526 +/- 149 vs. 461 +/- 156 min，p < 0.001]，而MIE组的失血量明显少于OE组（442 +/-612ml vs. 608 +/-591ml，p < 0.001）。MIE组中需要术后呼吸通气超过48小时的患者人群明显少于OE组（8.9 vs. 10.9%，p = 0.006）;然而，MIE组中30天内的再次手术率明显高于OE组（7.0 vs. 5.3%，p = 0.004）。MIE组和OE组在30天死亡率（分别为0.9%和1.1%）和手术死亡率（分别为2.5%和2.8%）方面没有显著差异。MIE组在食管切除术后的短期结局方面与传统OE组相当。它在减少术后呼吸系统并发症方面特别有益，但可能与较高的再手术率相关。
This study aimed to compare short-term outcomes of minimally invasive esophagectomy (MIE) with those of open esophagectomy (OE) for thoracic esophageal cancer using a nationwide Japanese database.Overall, 9584 patients with thoracic esophageal cancer who underwent esophagectomy at 864 hospitals in 2011-2012 were evaluated. We performed one-to-one matching between the MIE and OE groups on the basis of estimated propensity scores for each patient.After propensity score matching, operative time was significantly longer in the MIE group (n = 3515) than in the OE group (n = 3515) [526 +/- 149 vs. 461 +/- 156 min, p < 0.001], whereas blood loss was markedly less in the MIE group than in the OE group (442 +/- 612l vs. 608 +/- 591 ml, p < 0.001). The populations of patients who required more than 48 h of postoperative respiratory ventilation was significantly less in the MIE group than in the OE group (8.9 vs. 10.9%, p = 0.006); however, reoperation rate within 30 days was significantly higher in the MIE group than in the OE group (7.0 vs. 5.3%, p = 0.004). There were no significant differences between the MIE and OE groups in 30-day mortality rates (0.9 vs. 1.1%) and operative mortality rates (2.5 vs. 2.8%, respectively).MIE was comparable with conventional OE in terms of short-term outcome after esophagectomy. It was particularly beneficial in reducing postoperative respiratory complications, but may be associated with higher reoperation rates.