Minimally invasive esophagectomy - Outcomes in 222 patients
Minimally invasive esophagectomy - Outcomes in 222 patients
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DOI：
10.1097/01.sla.0000089858.40725.68
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发表时间：
2003-10-01
影响因子：
9
通讯作者：
Fernando, HC
中科院分区：
文献类型：
--
作者：
Luketich, JD;Alvelo-Rivera, M;Fernando, HC
背景资料：食管切除术传统上采用开放方法。大多数系列的结果包括死亡率超过5%，住院时间通常超过10天。MIE有可能改善这些结果，但只有少数小系列报道。方法：自1996年至2002年，对222例患者施行MIE。手术指征包括高度异型增生（n = 47）和癌症（n = 175）。78例（35.1%）患者接受了新辅助化疗，36例（16.2%）患者接受了放疗。最初，腹腔镜transshiatal方法（n 8），但随后我们的方法发展到包括胸腔镜动员（n = 214）。结果：有186名男性和36名女性。中位年龄为66.5岁（范围：39 - 89岁）。16例患者（7.2%）需要非紧急转为开放手术。206例（92.8%）患者成功完成MIE。重症监护病房的中位住院时间为1天（范围：1 - 30天）;住院时间为7天（范围：3 - 75天）。手术死亡率为1.4%（n = 3）。吻合口漏率为11.7%（n = 26）。平均随访19个月（范围1 - 68），生活质量评分与术前值和人群标准相似。结论：MIE手术疗效与开放手术相当或优于开放手术，具有广泛的微创和开放经验。在这个单一机构的经验，我们观察到较低的死亡率（1.4%）和较短的住院时间（7天）比大多数开放系列。鉴于这些结果，我们现在正在开发一项组间试验（ECOG 2202），以在多中心环境中评估MIE。
Background Data: Esophagectomy has traditionally been performed by open methods. Results from most series include mortality rates in excess of 5% and hospital stays frequently greater than 10 days. MIE has the potential to improve these results, but only a few small series have been reported. This report summarizes our experience of 222 cases.Methods: From 1996 to 2002, MIE was performed in 222 patients. Indications for operation included high-grade dysplasia (n = 47) and cancer (n = 175). Neoadjuvant chemotherapy was used in 78 (35.1%) and radiation in 36 (16.2%). Initially, a laparoscopic transhiatal approach was used (n 8), but subsequently our approach evolved to include thoracoscopic mobilization (n = 214).Results: There were 186 men and 36 women. Median age was 66.5 years (range, 39-89). Nonemergent conversion to open procedure was required in 16 patients (7.2%). MIE was successfully completed in 206 (92.8%) patients. The median intensive care unit stay was I day (range, 1-30); hospital stay was 7 days (range, 3-75). Operative mortality was 1.4% (n = 3). Anastomotic leak rate was 11.7% (n = 26). At a mean follow-up of 19 months (range, 1-68), quality of life scores were similar to preoperative values and population norms. Stage specific survival was similar to open seriesConclusions: MIE offers results as good as or better than open operation in our center with extensive minimally invasive and open experience. In this single institution experience, we observed a lower mortality rate (1.4%) and shorter hospital stay (7 days) than most open series. Given these results, we are now developing an intergroup trial (ECOG 2202) to assess MIE in a multicenter setting.