两种微创手术方式治疗颈段食管癌的对比研究
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摘要
目的通过对比新辅助化疗后行无气腹腹腔镜下食管内翻拔脱手术(laparoscopic transhiatal esophagectomy,LTE)和胸、腹腔镜联合食管癌根治手术(combined thoracoscopic and laparoscopic esophagectomy,CTLE)后患者的总生存期、无病生存期、术后咽喉反流发生率及术后并发症发生率,探讨LTE在颈段食管癌治疗中的价值。方法回顾性分析2009年10月至2014年12月在北京同仁医院行微创手术治疗的83例颈段食管癌患者的临床资料,其中27例行LTE,56例行CTLE。结果两组均无手术相关死亡和中转开腹、开胸。与CTLE相比,LTE术中出血量较少,手术时间较短,差异有显著性(P<0.05)。两组患者中位总生存期、无病生存期差异无显著性(P>0.05)。术后1年24h食管pH监测和食管测压显示LTE组咽喉反流较CTLE组轻(P<0.05)。两组术后肺部感染发生率差异无显著性(P>0.05)。结论与CTLE相比,LTE治疗颈段食管癌更为安全、有效。
Objective By comparing overall survival and disease-free survival, the incidence of postoperative gastric reflux and the incidence of postoperative complications in esophageal josephalbert without pneumoperitoneum laparoscopic(transhiatal esophagectomy(LTE) and combined thoracoscopic and laparoscopic esophagectomy(TLE) after neoadjuvant chemotherapy, illustrate the value of LTE in the treatment of cervical esophageal carcinoma. Method Retrospective analysis for the clinical data of minimally invasive surgery in total of 83 patients who havecervical esophageal carcinoma from 2009 to 2014 in Bejing Tongren Hospital. Among these patients,27 cases were performed using LTE, while the other 56 were performed using CLTE. Result There were no operation-related deaths or transitive laparotomy in the two groups, and there were less blood loss and shorter operation time in LTE compared with CTLE. There was no signi? cant difference in the median overall survival and disease-free survival between the two groups. 24 hours of esophageal pH monitoring and esophageal pressure measurement one year after surgery showed that laryngopharyngeal re? ux in the LTE group was lighter than that in the CTLE group. The incidence of postoperative pulmonary infection in the LTE group was lower than that in the CTLE group. Conclusion Compared with CTLE, LTE is more effective and safe in the treatment of cervical esophageal cancer.
Objective By comparing overall survival and disease-free survival, the incidence of postoperative gastric reflux and the incidence of postoperative complications in esophageal josephalbert without pneumoperitoneum laparoscopic(transhiatal esophagectomy(LTE) and combined thoracoscopic and laparoscopic esophagectomy(TLE) after neoadjuvant chemotherapy, illustrate the value of LTE in the treatment of cervical esophageal carcinoma. Method Retrospective analysis for the clinical data of minimally invasive surgery in total of 83 patients who havecervical esophageal carcinoma from 2009 to 2014 in Bejing Tongren Hospital. Among these patients,27 cases were performed using LTE, while the other 56 were performed using CLTE. Result There were no operation-related deaths or transitive laparotomy in the two groups, and there were less blood loss and shorter operation time in LTE compared with CTLE. There was no signi? cant difference in the median overall survival and disease-free survival between the two groups. 24 hours of esophageal pH monitoring and esophageal pressure measurement one year after surgery showed that laryngopharyngeal re? ux in the LTE group was lighter than that in the CTLE group. The incidence of postoperative pulmonary infection in the LTE group was lower than that in the CTLE group. Conclusion Compared with CTLE, LTE is more effective and safe in the treatment of cervical esophageal cancer.
引文
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[13]Swanstrom LL,Hansen P.Laparoscopic total esophagectomy[J].Arch Surg,1997,132(9):943-947.
[14]Tapias LF,Muniappan A,Wright CD,et al.Short and long-term outcomes after esophagectomy for cancer in elderly patients[J].Ann Thorac Surg,2013,95(5):1741-1748.
[15]Koh P,Turnbull G,Attia E,et al.Functional assessment of the cervical esophagus after gastric transposition and cervical esophagogastrostomy[J].Eur J Cardiothorac Surg,2004,25(4):480-485.
[16]Suzuki G,Yamazaki H,Ogo E,et al.Multimodal approach for cervical esophageal carcinoma:role of neoadjuvant chemotherapy[J].Anticancer Res,2014,34(4):1989-1992.
[17]Warner S,Chang YH,Paripati H,et al.Outcomes of minimally invasive esophagectomy in esophageal cancer after neoadjuvant chemoradiotherapy[J].Ann Thorac Surg,2014,97(2):439-445.
[18]Malaisrie SC,Untch B,Aranha GV,et al.Neoadjuvant chemoradiotherapy for locally advanced esophageal cancer:experience at a single institution[J].Arch Surg,2004,139(5):532-538.
[2]Sundaram A,Geronimo JC,Willer BL,et al.Survival and quality of life after minimally invasive esophagectomy:a single-surgeon experience[J].Surg Endosc,2012,26(1):168-176.
[3]Wu JX,Yu L,Li JY,et al.Gasless laparoscopically assisted transhiatal esophagectomy for upper esophageal carcinoma[J].Ann Surg Oncol,2015,22(3):1015-1019.
[4]Luketich JD,Alvelo-Rivera M,Buenaventura PO,et al.Minimally invasive esophagectomy:outcomes in 222 patients[J].Ann Surg,2003,238(4):486-494.
[5]Chou SH,Li HP,Lee JY,et al.Radical resection or chemoradiotherapy for cervical esophageal cancer?[J].World JSurg,2010,34(8):1832-1839.
[6]Tong DK,Law S,Kwong DL,et al.Current management of cervical esophageal cancer[J].World J Surg,2011,35(3):600-607.
[7]Hulscher JB,van Sandick JW,de Boer AG,et al.Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus[J].N Engl J Med,2002,347(21):1662-1669.
[8]Gockel I,Heckhoff S,Messow CM,et al.Transhiatal and transthoracic resection in adenocarcinoma of the esophagus:does the operative approach have an influence on the long-term prognosis?[J].World J Surg Oncol,2005,3:40.
[9]Omloo JM,Law SY,Launois B,et al.Short and long-term advantages of transhiatal and transthoracic oesophageal cancer resection[J].Eur J Surg Oncol,2009,35(8):793-797.
[10]Davies AR,For shaw MJ,Khan AA,et al.Transhiatal esophagectomy in a high volume institution[J].World J Surg Oncol,2008,6:88.
[11]Briez N,Piessen G,Bonnetain F,et al.Open versus laparoscopically-assisted oesophagectomy for cancer:a multicentre randomised controlled phase III trial-the MIRO trial[J].BMCCancer,2011,11:310.
[12]Law S,Wong J.Use of minimally invasive oesophagectomy for cancer of the oesophagus[J].Lancet Oncol,2002,3(4):215-222.
[13]Swanstrom LL,Hansen P.Laparoscopic total esophagectomy[J].Arch Surg,1997,132(9):943-947.
[14]Tapias LF,Muniappan A,Wright CD,et al.Short and long-term outcomes after esophagectomy for cancer in elderly patients[J].Ann Thorac Surg,2013,95(5):1741-1748.
[15]Koh P,Turnbull G,Attia E,et al.Functional assessment of the cervical esophagus after gastric transposition and cervical esophagogastrostomy[J].Eur J Cardiothorac Surg,2004,25(4):480-485.
[16]Suzuki G,Yamazaki H,Ogo E,et al.Multimodal approach for cervical esophageal carcinoma:role of neoadjuvant chemotherapy[J].Anticancer Res,2014,34(4):1989-1992.
[17]Warner S,Chang YH,Paripati H,et al.Outcomes of minimally invasive esophagectomy in esophageal cancer after neoadjuvant chemoradiotherapy[J].Ann Thorac Surg,2014,97(2):439-445.
[18]Malaisrie SC,Untch B,Aranha GV,et al.Neoadjuvant chemoradiotherapy for locally advanced esophageal cancer:experience at a single institution[J].Arch Surg,2004,139(5):532-538.