Transhiatal versus Ivor-Lewis oesophagectomy: Is there a difference?
Transhiatal versus Ivor-Lewis oesophagectomy: Is there a difference?
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DOI：
10.1046/j.1440-1622.1999.01520.x
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发表时间：
1999-03-01
期刊：
影响因子：
--
通讯作者：
Cox, MR
中科院分区：
文献类型：
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作者：
Rindani, R;Martin, CJ;Cox, MR
导言：食道癌根治性切除可采用经口入路或艾弗-刘易斯经胸手术。本研究的目的是比较两种技术治疗食道癌的发病率、30天死亡率和长期生存率，并为前瞻性随机试验的样本量计算提供数据。方法：回顾1986年1月至1996年12月发表的44个系列的结果。其中33篇文献报道了2675例食道成形术(THO)患者的手术结果，29篇文献报道了2808例患者的Ifor-Lewis食道切除术(LIO)的结果。两组术后呼吸系统并发症(THO组24%，LIO组25%)、心血管并发症(THO组12.4%，LIO组10.5%)、伤口感染(THO组8.8%，LIO组62%)和乳糜胸(THO组2.1%，LIO组3.4%)发生率无明显差异。吻合口瘘(THO组16%，LIO组10%)、吻合口狭窄(THO组28%，LIO组16%)和喉返神经损伤(THO组11.2%，LIO组4.8%)发生率明显高于THO组。30d死亡率：经瘘组为6.3%，艾弗-刘易斯食管组为9.5%。5年的总体长期生存率相似(THO组为24%，LIO组为26%)。结论：手术方式不是食道癌患者发病率和长期生存的重要决定因素。食道切除与吻合口并发症和喉返神经损伤的发生率较高相关。艾弗-刘易斯食道切除术的死亡率较高。为了证明这两种技术在发病率或长期存活率方面的显着差异，前瞻性随机试验的每一组都需要3100名患者。
Introduction: Curative oesophageal resection for carcinoma may be carried out by either the transhiatal or the Ivor-Lewis transthoracic technique. The aims of this study were to compare the morbidity, 30-day mortality and long-term survival of the two techniques in the treatment of oesophageal carcinoma and to provide data to calculate the sample sizes for a prospective randomized trial.Methods: Results from 44 series published between January 1986 and December 1996 were reviewed. Thirty-three papers reported results on 2675 patients having transhiatal (THO) and 29 papers reported results on 2808 patients having Ivor-Lewis oesophagectomy (ILO).Results: The two groups were comparable in terms of age, sex and stage of the disease. There was no apparent difference in postoperative morbidity between the two groups with respect to respiratory complications (24% for THO, 25% for ILO), cardiovascular complications (12.4% for THO, 10.5% for ILO), wound infection (8.8% for THO, 62% for ILO) and chylothorax (2.1% for THO, 3.4% for ILO). The transhiatal group appeared to have a higher incidence of anastomotic leaks (16% for THO, 10% for ILO), anastomotic strictures (28% for THO, 16% for ILO) and recurrent laryngeal nerve injuries (11.2% for THO, 4.8% for ILO). The 30-day mortality was 6.3% for transhiatal and 9.5% for Ivor-Lewis oesophagectomy. Overall long-term survival at 5 years was similar (24% for THO, 26% for ILO).Conclusions: The surgical approach to oesophagectomy was not an important determinant of morbidity and long-term survival in patients with oesophageal carcinoma. Transhiatal oesophagectomy was associated with a higher incidence of anastomotic complications and recurrent laryngeal nerve injury. Ivor-Lewis oesophagectomy had a higher mortality. In order to demonstrate a significant difference in morbidity or long-term survival between the two techniques 3100 patients would be required in each arm of a prospective randomized trial.