Successful transition from open to minimally invasive approach in Ivor Lewis esophagectomy: a single-center experience in Japan
Successful transition from open to minimally invasive approach in Ivor Lewis esophagectomy: a single-center experience in Japan
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Ivor Lewis 食管切除术从开放式手术到微创手术的成功过渡：日本的单中心经验
DOI：
10.1007/s00423-021-02150-8
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Mine Shinji
中科院分区：
文献类型：
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作者：
Kanamori Jun;Watanabe Masayuki;Kozuki Ryotaro;Toihata Tasuku;Otake Reiko;Takahashi Keita;Okamura Akihiko;Imamura Yu;Mine Shinji
目的本研究评估了我们机构中 Ivor Lewis 食管切除术 (ILE) 的手术结果，以及从开放式 ILE 向混合式或完全微创 ILE (MI-ILE) 的转变。方法纳入了 2013 年至 2020 年间因食管癌接受 ILE 的选定患者。我们回顾性调查患者的背景特征和短期手术结果。结果本期共858例食管切除术中，71例（8.3%）接受ILE，其中完全开放手术17例，混合MI-ILE 27例，全MI-ILE 27例。 ILE的主要适应症是远端食管或食管胃交界处的腺癌（33.8%）和既往接受过头颈癌治疗的患者（31.0%）。这些方法中，除组织学外，年龄、体重指数（BMI）、肿瘤位置、术前治疗和临床TNM分期等特征没有显着差异。与完全开放组和混合组相比，全MI-ILE组的总并发症发生率和严重并发症发生率均显着降低（总计70.6 vs. 66.6 vs. 37.0%，p=0.036；严重并发症35.3 vs. 44.4 vs. 11.1%，p=0.023），肺炎的发生率也显着降低（41.2 vs. 29.6 vs. 37.0%，p=0.023）。 7.4%，p=0.026) 和 全 MI-ILE 组术后狭窄（11.8 vs. 18.5 vs. 0%，p=0.001）显着减少。结论我们已经能够实现从完全开放到全 MI-ILE 的过渡，并具有更好的短期结果。对于选定的患者来说，采用线性吻合术进行全 MI-ILE 可以作为开放手术的良好替代方案，从而减少术后肺炎和吻合口狭窄的发生率。
PurposeThis study evaluates surgical outcomes of Ivor Lewis esophagectomy (ILE) in our institution, with the transition from open ILE to hybrid or totally minimally invasive ILE (MI-ILE).MethodsSelected patients who underwent ILE for esophageal cancer between 2013 and 2020 were included. We retrospectively investigated the patients’ background characteristics and the short-term surgical outcomes.ResultsIn this period, among a total of 858 esophagectomies, selected seventy-one patients (8.3%) underwent ILE, consisted of 17 cases with completely open procedures, 27 with hybrid MI-ILE, and 27 with total MI-ILE. The major indications for ILE were adenocarcinoma of the distal esophagus or esophagogastric junction (33.8%) and patients with prior treatment of head and neck cancer (31.0%). Among these approaches, there were no significant differences in the characteristics including age, body mass index (BMI), tumor location, preoperative therapy, and clinical TNM stage, except for histology. Compared to the completely open and hybrid groups, incidences of both total and severe complications in the total MI-ILE group were significantly lower (total 70.6 vs. 66.6 vs. 37.0%,p=0.036; severe 35.3 vs. 44.4 vs. 11.1%,p=0.023), and also, those of pneumonia (41.2 vs. 29.6 vs. 7.4%,p=0.026) and postoperative stricture (11.8 vs. 18.5 vs. 0%,p=0.001) were significantly fewer in the total MI-ILE group.ConclusionsWe have been able to achieve the transition from completely open to total MI-ILE with better short-term outcomes. Total MI-ILE with linear-stapled anastomosis can be a good alternative to open procedures for the selected patients with reducing the incidence of postoperative pneumonia and anastomotic stricture.