[1]尹哲,王志强,陈琪,等.经颈、经食管裂孔食管切除术对食管癌患者的疗效分析[J].陆军军医大学学报(原第三军医大学学报),2022,44(18):1867-1873.
　YIN Zhe,WANG Zhiqiang,CHEN Qi,et al.Efficacy of trans-cervical and trans-hiatal esophagectomy for esophageal carcinoma [J].J Amry Med Univ (J Third Mil Med Univ),2022,44(18):1867-1873.
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经颈、经食管裂孔食管切除术对食管癌患者的疗效分析(/HTML )
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陆军军医大学学报（原第三军医大学学报）[ISSN:1000-5404/CN:51-1095/R]

卷:
44卷
期数:
2022年第18期
页码:
1867-1873
栏目:
临床医学
出版日期:
2022-09-30

文章信息/Info

Title:
Efficacy of trans-cervical and trans-hiatal esophagectomy for esophageal carcinoma 
作者:
尹哲; 王志强; 陈琪; 蔡华荣
 重庆大学附属肿瘤医院胸外科
Author(s):
YIN Zhe;  WANG Zhiqiang;  CHEN Qi;  CAI Huarong

Department of Thoracic Surgery, Chongqing University Cancer Hospital, Chongqing Cancer Hospital, Chongqing, 400030, China

关键词:
食管癌; 经颈、经食管裂孔食管切除术; 胸腔镜食管切除术; 疗效
Keywords:
esophageal carcinoma;  trans-cervical and trans-hiatal esophagectomy;  thoracoscopic esophagectomy;  therapeutic efficacy
分类号:
R181.32; R730.56; R735.1
文献标志码:
A
摘要:

目的评估经颈、经食管裂孔食管切除术与胸腔镜食管切除术治疗食管癌患者的效果。方法选取重庆大学附属肿瘤医院2018年9月至2020年10月接受治疗的食管癌患者80例，采用简单随机分组的方法分为观察组和对照组。观察组40例接受经颈、经食管裂孔食管切除术，对照组40例接受胸腔镜食管切除术。比较两组患者术中出血、清扫纵隔淋巴结总数、手术时间、左或右侧喉返神经旁淋巴结清扫数量、入住ICU时间、术后疼痛评分、术后住院时间、PO2/FIO2、术后肺部感染和淋巴结转移等情况。结果80例患者均顺利完成手术。结果显示，观察组的手术时间少于对照组（200 min vs 235 min，Z=-3.700, P<0.001）。观察组的左侧喉返神经旁淋巴结清扫数量多于对照组(25.0% vs 2.5%, Z=2.568, P=0.010)。两组术后第1天（0% vs 17.5%, Z=-4.292, P<0.001）和第3天（12.5% vs 37.5%, Z=-3.363, P<0.001）疼痛评分、术后48 h PO2/FIO2（290 min vs 255 min, Z=3.747, P<0.001）、住院时间（7 d vs 8 d, Z=-2.119, P=0.034）、并发肺部感染率(χ2 =4.114, P=0.043)差异均有统计学意义。结论经颈、经食管裂孔切除术是治疗食管癌患者一种较好的手术方式，可为不能行开胸手术的患者提供治疗机会。

Abstract:

ObjectiveTo assess the efficacy of the trans-cervical and trans-hiatal esophagectomy versus thoracoscopic esophagectomy in patients with esophageal carcinoma. MethodsA total of 80 esophageal carcinoma patients undergoing surgical treatment in our hospital from September 2018 to October 2020 were enrolled in this study, and they were divided into observation group (n=40) and control group (n=40). The patients out of the observation group underwent the trans-cervical and trans-hiatal esophagectomy, and those from the control group underwent the thoracoscopic esophagectomy. The preoperative, intraoperative and postoperative data were analyzed between the 2 groups, regarding intraoperative blood loss, number of dissected mediastinal lymph nodes, operation time, number of lymph nodes in left para-recurrent laryngeal nerve (para-RLN) or right para-RLN, length of staying in intensive care unit (ICU), postoperative pain score, length of postoperative stay, PO2/fraction of inspiration O2 (PO2/FIO2), pulmonary infection, and lymphatic metastasis. ResultsThe operation was successfully performed in all 80 patients. The patients in the observation group had shorter operation time (200 vs 235 min, Z=-3.700, P<0.001) and larger number of dissected mediastinal lymph nodes in left para-RLN (25.0% vs 2.5%, Z=2.568, P=0.010) than those in the control group. Significant differences were observed in the pain scores of postoperative day 1 (0% vs 17.5%, Z=-4.292, P<0.001) and day 3 (12.5% vs 37.5%, Z=-3.363, P<0.001), postoperative 48-h PO2/FIO2 (290 vs 255 min, Z=3.747, P<0.001), length of postoperative stay (7 d vs 8 d, Z=-2.119, P=0.034), and incidence of postoperative pulmonary infection (χ2=4.114, P=0.043) between the 2 groups. ConclusionTrans-cervical and trans-cervical esophagectomy is a good approach in treatment of esophageal carcinoma, and may provide an option to the patients who cannot suffer from the thoracotomy.

参考文献/References:

[1]PAKZAD R, MOHAMMADIAN-HAFSHEJANI A, KHOSRAVI B, et al. The incidence and mortality of esophageal cancer and their relationship to development in Asia[J]. Ann Transl Med, 2016, 4(2): 29. DOI: 10.3978/j.issn.2305-5839.2016.01.11. 
 
[2]CHEN W Q, ZHENG R S, BAADE P D,et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2): 115-132. DOI: 10.3322/caac.21338. 
 
[3]SIEGEL R L, MILLER K D, JEMAL A. Cancer statistics, 2015[J]. CA Cancer J Clin, 2015, 65(1): 5-29. DOI: 10.3322/caac.21254. 
 
[4]AJANI J A, D’AMICO T A, BENTREM D J,et al. Esophageal and esophagogastric junction cancers, version 2.2019, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2019, 17(7): 855-883. DOI: 10.6004/jnccn.2019.0033. 
 
[5]YIBULAYIN W,ABULIZI S, LV H B, et al. Minimally invasive oesophagectomy versus open esophagectomy for resectable esophageal cancer: a meta-analysis[J]. World J Surg Oncol, 2016, 14(1): 304. DOI: 10.1186/s12957-016-1062-7. 
 
[6]STRAATMAN J, VAN DER WIELEN N, CUESTA M A, et al. Minimally invasive versus open esophageal resection: three-year follow-up of the previously reported randomized controlled trial: the TIME trial[J]. Ann Surg, 2017, 266(2): 232-236. DOI: 10.1097/SLA.0000000000002171. 
 
[7]FERNANDEZ-BUSTAMANTE A, FRENDL G, SPRUNG J, et al. Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: a multicenter study by the perioperative research network investigators[J]. JAMA Surg, 2017, 152(2): 157-166. DOI: 10.1001/jamasurg.2016.4065. 
 
[8]VAN HAREN R M, MEHRAN R J, MENA G E, et al. Enhanced recovery decreases pulmonary and cardiac complications after thoracotomy for lung cancer[J]. Ann Thorac Surg, 2018, 106(1): 272-279. DOI: 10.1016/j.athoracsur.2018.01.088. 
 
[9]GILLINOV A M, HEITMILLER R F. Strategies to reduce pulmonary complications after transhiatal esophagectomy[J]. Dis Esophagus, 2017, 11(1): 43-47. DOI: 10.1093/dote/11.1.43. 
 
[10]The Society of Thoracic Surgeons. STS general thoracic surgery database. July 2018; Available at: https://www.sts.org/registries-research-center/sts-national-database/sts-general-thoracic-surgery-database. Accessed August 02, 2020. 
 
[11]YU L, WU J X, GAO Y S,et al. Pros and cons of the gasless laparoscopic transhiatal esophagectomy for upper esophageal carcinoma[J]. Surg Endosc, 2016, 30(6): 2382-2389. DOI: 10.1007/s00464-015-4488-z. 
 
[12]TAKEDA F R, SALLUM R AA, RIBEIRO U Jr, et al. Laparoscopic transhiatal esophagectomy in esophageal cancer patients with high-risk post-operative complications[J]. Dis Esophagus, 2022, 35(1): doab022. DOI:10.1093/dote/doab022. 
 
[13]WANG Z Q, JIANG Y Q, XU W,  et al. A novel technique for cervical gastro-oesophageal anastomosis during minimally invasive oesophagectomy[J]. Int J Surg, 2018, 53: 221-229. DOI: 10.1016/j.ijsu.2018.03.072.
 
[14]TAKEUCHI H, MIYATA H, OZAWA S, et al. Comparison of short-term outcomes between open and minimally invasive esophagectomy for esophageal cancer using a nationwide database in Japan[J]. Ann Surg Oncol, 2017, 24(7): 1821-1827. DOI: 10.1245/s10434-017-5808-4. 
 
[15]GOTTLIEB-VEDI E, KAUPPILA J H, MATTSSON F,et al. Long-term survival in esophageal cancer after minimally invasive esophagectomy compared to open esophagectomy[J]. Ann Surg, 2021: 2021Jan20. DOI: 10.1097/SLA.0000000000004645. 
 
[16]YOSHIDA N, YAMAMOTO H, BABA H,et al. Can minimally invasive esophagectomy replace open esophagectomy for esophageal cancer? latest analysis of 24, 233 esophagectomies from the Japanese national clinical database[J]. Ann Surg, 2020, 272(1): 118-124. DOI: 10.1097/SLA.0000000000003222. 
 
[17]YAMASHITA K, WATANABE M, MINE S, et al. Minimally invasive esophagectomy attenuates the postoperative inflammatory response and improves survival compared with open esophagectomy in patients with esophageal cancer: a propensity score matched analysis[J]. Surg Endosc, 2018, 32(11): 4443-4450. DOI: 10.1007/s00464-018-6187-z. 
 
[18]KUKAR M, BEN-DAVID K, PENG J S,et al. Minimally invasive ivor lewis esophagectomy with linear stapled anastomosis associated with low leak and stricture rates[J]. J Gastrointest Surg, 2020, 24(8): 1729-1735. DOI: 10.1007/s11605-019-04320-y. 
 
[19]JEON H W, SUNG S W. Minimally invasiveivor lewis esophagectomy for esophageal cancer[J]. J Vis Surg, 2016, 2(1): 165. DOI: 10.21037/jovs.2016.10.03. 
 
[20]SCHLOTTMANN F, STRASSLE P D, PATTI M G.Transhiatal vs. transthoracic esophagectomy: a NSQIP analysis of postoperative outcomes and risk factors for morbidity[J]. J Gastrointest Surg, 2017, 21(11): 1757-1763. DOI: 10.1007/s11605-017-3572-1. 
 
[21]MERTENS A C, KALFF M C, ESHUIS W J,et al. Transthoracic versus transhiatal esophagectomy for esophageal cancer: a nationwide propensity score-matched cohort analysis[J]. Ann Surg Oncol, 2021, 28(1): 175-183. DOI: 10.1245/s10434-020-08760-8. 
 
[22]LEERS J M, KNEPPER L, VAN DER VEEN A,et al. The CARDIA-trial protocol: a multinational, prospective, randomized, clinical trial comparing transthoracic esophagectomy with transhiatal extended gastrectomy in adenocarcinoma of the gastroesophageal junction (GEJtype II[J]. BMC Cancer, 2020, 20(1): 781. DOI: 10.1186/s12885-020-07152-1. 
 
[23]REZAEI R, MASUOM S H F, SOROUSH N,et al. Comparison of transhiatal esophagectomy using a mediastinoscope with transhiatal esophagectomy by the classic method[J]. Asian Cardiovasc Thorac Ann, 2021, 29(1): 33-37. DOI: 10.1177/0218492320963976. 
 
[24]BOSHIER P R, ANDERSON O, HANNA G B. Transthoracic versustranshiatal esophagectomy for the treatment of esophagogastric cancer: a meta-analysis[J]. Ann Surg, 2011, 254(6): 894-906. DOI: 10.1097/SLA.0b013e3182263781. 
 
[25]TORRE L A, BRAY F, SIEGEL R L, et al. Global cancer statistics, 2012[J]. CA Cancer J Clin, 2015, 65(2): 87-108. DOI:10.3322/caac.21262. 
 
[26]TACHIMORI Y, OZAWA S, NUMASAKI H, et al. Efficacy of lymph node dissection by node zones according to tumor location for esophageal squamous cell carcinoma[J]. Esophagus, 2016, 13: 1-7. DOI: 10.1007/s10388-015-0515-3. 
 
[27]CHEN J Q, WU S G, ZHENG X W, et al. Cervical lymph node metastasis classified as regional nodal staging in thoracic esophageal squamous cell carcinoma after radical esophagectomy and three-field lymph node dissection[J]. BMC Surg, 2014, 14: 110. DOI: 10.1186/1471-2482-14-110. 
 
[28]LI KK, WANG Y J, LIU X H, et al. Thoracoscopic-laparoscopic esophagectomy and two-field lymph node dissection[J]. J Thorac Dis, 2019, 11(6): 2571-2575. DOI: 10.21037/jtd.2019.05.80. 
 
[29]FUJIWARA H, SHIOZAKI A, KONISHI H, et al. Perioperative outcomes of single-port mediastinoscope-assisted transhiatal esophagectomy for thoracic esophageal cancer[J]. Dis Esophagus, 2017, 30(10): 1-8. DOI: 10.1093/dote/dox047. 
 
[30]OKUMURA H, UCHIKADO Y, MATSUMOTO M,et al. Clinical significance of mediastinoscope-assisted transhiatal esophagectomy in patients with esophageal cancer[J]. Langenbecks Arch Surg, 2015, 400(6): 699-706. DOI: 10.1007/s00423-015-1330-y. 
 

更新日期/Last Update: 2022-09-23