Open Versus Minimally Invasive Esophagectomy Trends of Utilization and Associated Outcomes in England
Open Versus Minimally Invasive Esophagectomy Trends of Utilization and Associated Outcomes in England
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DOI：
10.1097/sla.0b013e3181dd4e8c
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发表时间：
2010-08-01
影响因子：
9
通讯作者：
Aylin, Paul
中科院分区：
文献类型：
--
作者：
Lazzarino, Antonio Ivan;Nagpal, Kamal;Aylin, Paul
目的：评估在过去的12年（1996/1997-2007/2008）中，在英格兰的微创食管切除术的吸收趋势，并比较其临床结果与开放式食管切除术后。背景资料摘要：在英国，每年约有7400人受到影响。然而，食管切除术后的预后很差。即使在“治愈性”手术后，5年生存率也不超过25%。微创方法食管切除术引起了人们的注意，作为一个潜在的微创替代传统surgery.Methods：食管癌食管切除术患者的数据提取自国家行政数据库。关注的结局为院内死亡率、30天院内死亡率、30天总死亡率（即，院内和院外）、365天总死亡率、28天急诊再入院率和住院时间。分层逻辑回归用于确定微创食管切除术（MIE）的影响，调整后的结果，年龄，性别，社会经济剥夺，和comormality.Results：在12年的研究期间，共进行了18,673食管切除术。随着时间的推移，微创手术的使用呈指数级增长（从1996/1997年的0.6%增加到2007/2008年的16.0%）。提示MIE患者的1年生存率高于开放性食管切除术患者（OR = 0.68，95% CI = 0.46-1.01，P = 0.058）。除了可能的1年生存率外，与接受传统手术的患者相比，选择MIE的患者显示出相似的死亡率和住院时间结局。这些结果需要在大规模随机对照试验中得到证实。
Objective: To assess the trends in uptake of minimal invasive esophagectomy in England over the last 12 years (1996/1997-2007/2008) and to compare their clinical outcomes with those after open esophagectomy.Summary of Background Data: Around 7400 people are affected each year in the United Kingdom. Prognosis following esophageal resection is, however, poor. Even after "curative" surgery, 5-year survival rates do not exceed 25%. The minimally invasive approach to esophagectomy has attracted attention as a potentially less invasive alternative to conventional surgery.Methods: Data on patients undergoing esophagectomy for esophageal cancer were extracted from a national administrative database. The outcomes of interest were in-hospital mortality, 30-day in-hospital mortality, 30-day total (ie, in and out of hospital) mortality, 365-day total mortality, 28-day emergency readmission rates, and length of hospital stay. Hierarchical logistic regression was used to identify the effect of minimal invasive esophagectomy (MIE) on the outcomes after adjustment for age, gender, socioeconomic deprivation, and comorbidity.Results: A total of 18,673 esophagectomies were performed over the 12-year study period. The use of minimal access surgery increased exponentially over time (from 0.6% in 1996/1997 to 16.0% in 2007/2008). There was a suggestion that patients undergoing MIE had better 1-year survival rates than patients receiving open esophagectomy (OR = 0.68, 95% CI = 0.46-1.01, P = 0.058).Conclusion: The uptake of MIE in England is increasing exponentially. With the possible exception of 1-year survival, patients selected for MIE demonstrated similar mortality and length of stay outcomes when compared with those undergoing conventional surgery. These results need to be confirmed in large-scale randomized controlled trials.