A descriptive comparison of postoperative outcomes between hybrid mediastino-thoracoscopic approach and conventional thoracoscopic esophagectomy for esophageal cancer
A descriptive comparison of postoperative outcomes between hybrid mediastino-thoracoscopic approach and conventional thoracoscopic esophagectomy for esophageal cancer
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DOI：
10.1007/s00464-022-09818-2
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发表时间：
2022-12-13
影响因子：
3.1
通讯作者：
Hanazaki, Kazuhiro
中科院分区：
文献类型：
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作者：
Kitagawa, Hiroyuki;Yokota, Keiichiro;Hanazaki, Kazuhiro
本研究的目的是比较混合纵隔胸腔镜入路与常规胸腔镜入路的结果，并确定混合入路的优缺点。方法回顾性分析2009年7月至2021年6月期间接受胸腔镜食管切除术治疗食管癌的172例患者，不包括补救性手术。在纵隔镜下，淋巴结从颈部左侧的小切口切除到主动脉弓，仰卧双肺通气。此后，在俯卧位胸腔镜下切开中下纵隔和右上纵隔。比较51例混合入路患者和121例常规入路患者的人口统计学、手术结果、术后并发症和术后复发模式。结果混合组老年患者较多（71岁vs. 67岁，P = 0.010），心血管疾病较多（33.3% vs. 16.7%, P = 0.021），术前化疗率较低（49.0% vs. 69.4%, P = 0.015），右肺衰竭时间较短（196 min vs. 264 min, P < 0.001）。两组术后声音沙哑差异无统计学意义（31.4% vs. 27.3%, P = 0.584），胸骨切迹水平胸椎距离差异有统计学意义（杂交组41 mm vs.常规组48 mm， P = 0.029）。在logistic分析中，胸椎距离小于45 mm是术后声音嘶哑的独立危险因素（优势比3.636,95%可信区间1.054 ~ 12.546;P = 0.041）。结论纵隔-胸腔镜混合入路适用于老年人或心肺疾病患者，安全可靠；然而，胸椎距离短可能是术后喉返神经麻痹的危险因素。
Background The purpose of this study was to compare the results of the hybrid mediastino-thoracoscopic approach with that of the conventional thoracoscopic approach and to identify the advantages and disadvantages of the hybrid approach. Methods We retrospectively analyzed 172 patients who underwent thoracoscopic esophagectomy for esophageal cancer from July 2009 to June 2021, excluding salvage surgery. In the mediastinoscopic approach, the lymph nodes were dissected from a small incision in the left aspect of the neck to the aortic arch with supine double-lung ventilation. Thereafter, the middle-to-lower mediastinum and right superior mediastinum were dissected thoracoscopically in the prone position. The patients' demographics, surgical outcomes, postoperative complications, and postoperative recurrence patterns were compared between 51 patients in the hybrid approach and 121 patients in the conventional approach. Results The hybrid group had more elderly patients (71 years vs. 67 years; P = 0.010), more cardiovascular disease (33.3% vs. 16.7%; P = 0.021), lower rates of preoperative chemotherapy (49.0% vs. 69.4%; P = 0.015), and shorter right lung collapse time (196 min vs. 264 min; P < 0.001). Postoperative hoarseness was not different between the two groups (31.4% vs. 27.3%; P = 0.584), and there was a significant difference in the sternal-vertebral distance at the level of the sternal notch (41 mm in the hybrid group vs. 48 mm in the conventional group; P = 0.029). The sternal-vertebral distance of less than 45 mm was an independent risk factor for postoperative hoarseness in the logistic analysis (odds ratio 3.636, 95% confidence interval 1.054-12.546; P = 0.041). Conclusion The hybrid mediastino-thoracoscopic approach could be safely adapted to elderly or cardiopulmonary diseased patients; however, short sternal-vertebral distance might be a risk factor of postoperative recurrent laryngeal nerve palsy.