• 作者：Sorin Niky Mocanu ; M. Carmen Balagu¨¦ Ponz ; Eduardo Maria Targarona Soler ; Marta Roque Figuls ; Manel Trias Folch
• 关键词：Complicaciones respiratorias ; Cirugí ; a mí ; nimamente invasiva ; Toracoscopia ; Esofagectomí ; a ; Derrame pleural ; Insuficiencia respiratoria
• 刊名：Ciruga Espa?ola
• 出版年：2013
• 出版时间：November, 2013
• 年：2013
• 卷：91
• 期：9
• 页码：563-573
• 全文大小：706 K

Introduction

A systematic review of the literature was performed with the aim to determine differences in the rate of respiratory complications after esophagectomy for esophageal cancer using minimally invasive access vs traditional thoracic access.

Methods

A literature search was performed using Medline and Cochrane Library, identifying studies that compared the 2 types of thoracic access, regardless of the type of abdominal access (laparotomy/laparoscopy). The studies selected described respiratory complications in absolute numbers and different categories. Studies that considered minithoracotomy as a minimally invasive technique were excluded. Inclusion criteria were: studies decribing the different types of respiratory complications (9 in total), and analysing the most common complications: respiratory infection, respiratory failure and pleural effusion.

Results

Nine studies were selected (one prospective randomized trial and 8 case control studies) including 1,190 patients, 1,167 of which were operated on for esophageal cancer: 482 patients by thoracotomy and 708 by thoracoscopy. Three studies included definitions of respiratory complications, and one stratified them. The more frequent complications that allowed a meta-analysis were: respiratory infections, pleural effusion, and respiratory failure. No significant differences were found between the 2 types of access in the global analysis.

Discussion

The type of thoracic access (thoracotomy or thoracoscopy) does not seem to influence the development of respiratory complications after esophagectomy for cancer. However, the design of the studies analysed, the absence of clear definitions and stratification of the complications makes this conclusion questionable. A consensus on the definition of complications and further prospective randomized clinical trials are necessary.