Factors influencing difficulty of the thoracic procedure in minimally invasive esophagectomy
Factors influencing difficulty of the thoracic procedure in minimally invasive esophagectomy
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DOI：
10.1007/s00464-015-4743-3
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发表时间：
2016-10-01
影响因子：
3.1
通讯作者：
Sano, Takeshi
中科院分区：
文献类型：
--
作者：
Okamura, Akihiko;Watanabe, Masayuki;Sano, Takeshi
微创食管切除术（MIE）在全球范围内越来越多地被实施。在进行MIE时，我们有时会遇到困难，因为狭窄的上纵隔或中下胸食管被椎体的投影所隐藏。然而，没有关于解剖因素对MIE难度影响的报道。本研究的目的是评估解剖因素是否可能与MIE中胸部手术的难度有关。我们调查了2013年至2015年期间接受MIE治疗原发性食管癌的87例连续患者，并创建了新的指标来评估术前CT图像上的上纵隔狭窄和中胸部椎体投影。我们评估了临床病理和解剖因素，并确定影响MIE胸部手术难度的因素。选择胸外科手术时间作为代表技术难度的变量，平均胸外科手术时间为280.2 +/- 52.5 min。这些指标与患者因素（如年龄、性别和体重指数）之间无显著相关性。上纵隔狭窄程度与椎体突出度有显著相关性（P < 0.01）。在临床病理学和解剖学因素中，在多元线性回归分析中，胸外科手术期间失血、胸导管切除和椎体突出独立地与胸外科手术时间延长相关（分别为p = 0.01、0.03和< 0.01）。其他因素包括上纵隔狭窄无统计学意义。这是第一个研究揭示解剖因素对MIE胸部手术难度的影响。胸椎中段椎体投影是术前预测MIE手术难度的有效工具。
Minimally invasive esophagectomy (MIE) is being increasingly performed worldwide. When performing MIE, we sometimes experienced difficulties due to a narrow upper mediastinum or a middle to lower thoracic esophagus hidden by the projection of the vertebral body. However, there were no reports regarding the influence of anatomical factors on the difficulty of performing MIE. The aim of this study was to evaluate whether anatomical factors could be related to the difficulty of the thoracic procedure in MIE.We investigated 87 consecutive patients undergoing MIE for primary esophageal cancer between 2013 and 2015 and created novel indices to assess the upper mediastinal narrowness and vertebral body projection at middle thoracic part on preoperative computed tomography images. We assessed clinicopathological and anatomical factors and determined the factors influencing the thoracic procedural difficulty in MIE. The thoracic procedure duration was selected as the variable representing technical difficulty.The mean thoracic procedure duration was 280.2 +/- 52.5 min. There were no significant correlations between the indices and patient factors such as age, sex, and body mass index. Meanwhile, there was a significant correlation between the upper mediastinal narrowness and the vertebral body projection (p < 0.01). Of the clinicopathological and anatomical factors, blood loss during the thoracic procedure, thoracic duct resection, and vertebral body projection independently were related to the prolonged thoracic procedure duration in multiple linear regression analysis (p = 0.01, 0.03, and < 0.01, respectively). The other factors including upper mediastinal narrowness were not statistically significant.This is the first study to reveal the influence of anatomical factors on the difficulty of the thoracic procedure in MIE. The vertebral body projection at middle thoracic part appears to be a useful tool for predicting the thoracic procedural difficulty in MIE preoperatively.