Minimally invasive esophagectomy versus open esophagectomy, a symptom assessment study
Minimally invasive esophagectomy versus open esophagectomy, a symptom assessment study
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DOI：
10.1111/j.1442-2050.2010.01113.x
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发表时间：
2011-04-01
影响因子：
2.6
通讯作者：
Hofstetter, W.
中科院分区：
文献类型：
--
作者：
Mehran, R.;Rice, D.;Hofstetter, W.
P>；微创食道切除术(MIE)被用来降低与开放食道切除术相关的发病率。反流和倾倒综合征是食道切除术后患者最主要的功能性主诉。这项研究比较了MIE和开腹食道切除术的功能益处。这项研究纳入了2004至2009年间接受微创或开放食道切除术的癌症患者。MIE组中没有患者接受幽门成形术或肌切开术。MIE组中的每个患者通过倾向匹配与开放食管组中的一个患者配对。匹配变量包括年龄、种族、性别、术前治疗、既往癌症病史、美国麻醉学家协会风险量表、工作状态、临床分期、体重指数、组织学、吻合口水平和手术后时间。这些患者被要求回答26个关于他们的反流和倾倒的问题，使用有效的问卷。共有181名患者参加了这项研究。从这一组中，创建了44对患者并用于分析。中位随访期：MIE组为12.1个月，开放组为18.3个月。MIE组反流评分稍差(5.5vs3.5vs3.5，P=0.021)。两组倾倒症状差异无统计学意义。在几乎三分之一的患者中，倾倒问卷中最常见的主诉是早饱、腹部不适、恶心和腹泻。MIE组患者满意或非常满意的比例为77%，开放组为93%(P=0.287)。未行幽门成形术的MIE术后的反流、倾倒和总体满意度与开腹食道切除加幽门引流术后的结果相当。
P>Minimally invasive esophagectomy (MIE) is used with hope to decrease the morbidity associated with an open esophagectomy. Reflux and dumping syndromes are the most important functional complaints in patients after esophagectomy. This study compares the functional benefits of MIE with open esophagectomy. The study enrolled patients who underwent either minimally invasive or open esophagectomy for cancer between 2004 and 2009. No patients in the MIE group had a pyloroplasty or myotomy. Each patient in the MIE group was paired to a patient in the open esophagectomy group via propensity matching. Matching variables included age, race, gender, preoperative treatment, history of prior cancer, American Society of Anesthesiologists Risk Scale, performance status, clinical stage, body mass index, histology, level of anastomosis, and time elapsed since surgery. The patients were asked to answer 26 questions about their reflux and dumping using validated questionnaires. A total of 181 patients were included in the study. From this group, 44 pairs of patients were created and used for the analysis. The median follow-up was 12.1 months for the MIE group and 18.3 months for the open group. The reflux score was slightly worse in the MIE group (5.5 versus 3.5, P = 0.021). There was no difference in the dumping symptoms between the two groups. The most common complaints seen in the dumping questionnaire in almost one-third of all patients were early satiety, abdominal discomfort, nausea, and diarrhea. Of the patients, 77% were satisfied or very satisfied with their condition in the MIE group compared with 93% in the open group (P = 0.287). Reflux, dumping, and overall satisfaction after MIE without pyloroplasty are comparable with those obtained after open esophagectomy with a pyloric drainage procedure.