胸腹腔镜联合Ivor Lewis术与McKeown术治疗胸中下段食管癌近期疗效的系统评价与Meta分析
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摘要
目的比较胸腹腔镜胸中下段食管癌微创手术Ivor Lewis术式与Mc Keown术式的近期疗效,探讨食管癌微创切除术的最佳手术方式。方法计算机检索Pub Med、EMbase、The Cochrane Library、中国生物医学文献总库(CBM)、中国知网(CNKI)、万方数据库及维普数据库(VIP)公开发表的微创Ivor Lewis术式与微创Mc Keown术式的比较研究,检索时间均为数据库建库至2016年3月,采用Rev Man 5.3软件进行数据分析。结果 5篇文献共纳入870例食管癌手术患者,其中Ivor Lewis组416例,Mc Keown组454例。Newcastle Ottawa质量评分均在7~8分。Meta分析结果显示:相比较于Mc Keown组,Ivor Lewis组手术时间较短(WMD=–34.67,95%CI–53.70~–15.65,P=0.000 4),喉返神经损伤(OR=0.23,95%CI 0.12~0.44,P<0.000 01)、吻合口瘘(OR=0.24,95%CI 0.14~0.41,P<0.000 01),吻合口狭窄(OR=0.30,95%CI 0.16~0.55,P=0.000 01),肺部并发症(OR=0.25,95%CI0.15~0.43,P<0.000 01)发生率较低;在术中出血量、术后住院时间、住院费用、乳糜胸发生率方面两组差异无统计学意义(P>0.05);而Mc Keown组淋巴结清扫数目较多(WMD=–1.16,95%CI–2.00~–0.31,P=0.007)。结论在胸腹腔镜治疗胸中下段食管癌微创术式中,Ivor Lewis术式在近期疗效上较Mc Keown术式有一定优势,但Mc Keown术式清扫淋巴结数目更多。
Objective To compare the short-term outcomes between Ivor Lewis esophagectomy and Mc Keown esophagectomy under thoracoscopy and laparoscopy for thoracic middle-lower esophageal carcinoma and to investigate the optimal approach. Methods The relevant literatures(from database foundation to March 2016) comparing minimally invasive Ivor Lewis esophagectomy and minimally invasive Mc Keown esophagectomy were searched through Pub Med, EMbase, The Cochrane Library, CBM, CNKI, Wanfang Data and VIP. Rev Man 5.3 software was used for data analysis. Results A total of 870 patients in 5 studies were reviewed and data were pooled for analysis. The score of Newcastle Ottawa for the literatures was 7-8 points. The results showed that compared with the Mc Keown group, Ivor Lewis group had shorter operation time(WMD=–34.67, 95% CI –53.70 to –15.65, P=0.000 4), less recurrent laryngeal nerve injuries(OR=0.23, 95% CI 0.12 to 0.44, P<0.000 01), anastomotic leakage(OR=0.24, 95% CI 0.14 to 0.41, P<0.000 01),anastomotic stenosis(OR=0.30, 95% CI 0.16 to 0.55, P=0.000 01), and pulmonary complications(OR=0.25, 95% CI 0.15 to0.43, P<0.000 01). There was no significant difference between the two groups in intraoperative blood loss,postoperative stay, hospitalization cost and chylothorax incidence. The Mc Keown group was associated with much more lymph nodes dissection(WMD=–1.16, 95% CI –2.00 to –0.31, P=0.007) than the Ivor Lewis group. Conclusion Compared with Mc Keown esophagectomy combined with thoracoscopy and laparoscopy, Ivor Lewis esophagectomy combined with thoracoscopy and laparoscopy has some advantages for thoracic middle-lower esophageal carcinoma, but a greater number of lymph nodes are dissected in Mc Keown procedure.
Objective To compare the short-term outcomes between Ivor Lewis esophagectomy and Mc Keown esophagectomy under thoracoscopy and laparoscopy for thoracic middle-lower esophageal carcinoma and to investigate the optimal approach. Methods The relevant literatures(from database foundation to March 2016) comparing minimally invasive Ivor Lewis esophagectomy and minimally invasive Mc Keown esophagectomy were searched through Pub Med, EMbase, The Cochrane Library, CBM, CNKI, Wanfang Data and VIP. Rev Man 5.3 software was used for data analysis. Results A total of 870 patients in 5 studies were reviewed and data were pooled for analysis. The score of Newcastle Ottawa for the literatures was 7-8 points. The results showed that compared with the Mc Keown group, Ivor Lewis group had shorter operation time(WMD=–34.67, 95% CI –53.70 to –15.65, P=0.000 4), less recurrent laryngeal nerve injuries(OR=0.23, 95% CI 0.12 to 0.44, P<0.000 01), anastomotic leakage(OR=0.24, 95% CI 0.14 to 0.41, P<0.000 01),anastomotic stenosis(OR=0.30, 95% CI 0.16 to 0.55, P=0.000 01), and pulmonary complications(OR=0.25, 95% CI 0.15 to0.43, P<0.000 01). There was no significant difference between the two groups in intraoperative blood loss,postoperative stay, hospitalization cost and chylothorax incidence. The Mc Keown group was associated with much more lymph nodes dissection(WMD=–1.16, 95% CI –2.00 to –0.31, P=0.007) than the Ivor Lewis group. Conclusion Compared with Mc Keown esophagectomy combined with thoracoscopy and laparoscopy, Ivor Lewis esophagectomy combined with thoracoscopy and laparoscopy has some advantages for thoracic middle-lower esophageal carcinoma, but a greater number of lymph nodes are dissected in Mc Keown procedure.
引文
[1]Pennathur A,Gibson MK,Jobe BA,et al.Oesophageal carcinoma.S Afi Med J,1981,47(47):348-351.
2Enzinger PC,Mayer RJ.Esophageal cancer.N Engl J Med,2003,349(23):2241-2252.
3毛友生,赫捷,高树庚,等.我国食管癌外科治疗目前存在的热点争议与未来研究方向.中华胃肠外科杂志,2015,18(9):851-854.
4Pennathur A,Luketich JD.Resection for esophageal cancer:strategies for optimal management.Ann Thorac Surg,2008,85(2):S751-S756.
5Moher D,Liberati A,Tetzlaff J,et al.Preferred reporting items for systematic reviews and meta-analyses:The PRISMA statement.Int J Surg,2009,7(9):889-896.
6Stang A.Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in metaanalyses.Eur J Epidemiol,2010,25(9):603-605.
7孟庆江.微创Mc Keown与Ivor-Lewis手术治疗中下段食管癌临床分析.中国医学创新,2016,13(1):17-20.
8梅闪闪,刘继先,吴昊,等.微创荷包钳法Ivor-Lewis术与Mc Keown术治疗中下段食管癌的近期疗效分析.重庆医科大学学报,2016,41(1):89-93.
9Zhai C,Liu Y,Li W,et al.A comparison of short-term outcomes between Ivor-Lewis and Mc Keown minimally invasive esophagectomy.J Thorac Dis,2016,7(12):2352-2358.
10吴汉然,解明然,柳常青,等.微创Ivor-Lewis术与Mc Keown术治疗胸中下段食管癌近期疗效比较.中华胸心血管外科杂志,2014,30(11):649-652.
11林济红,康明强,林江波,等.胸腹腔镜联合食管癌Ivor-Lewis术与Mc Keown术近期疗效比较.中华胃肠外科杂志,2014,17(9):888-891.
12Maas KW,Cuesta MA,Henegouwen MIVB,et al.Quality of life and late complications after minimally invasive compared to open esophagectomy:Results of a randomized trial.World J Surg,2015,39(8):1-8.
13Zhang ZM,Wang Y,Gao YS,et al.Minimally invasive esophagectomy for esophageal carcinoma:clinical analysis of 160cases.Zhonghua Wei Chang Wai Ke Za Zhi,2012,15(9):934-937.
14Mei X,Xu M,Guo M,et al.Minimally invasive Ivor-Lewis oesophagectomy is a feasible and safe approach for patients with oesophageal cancer.ANZ J Surg,2016,86(4):274.
15Smithers BM,Gotley DC,Martin I,et al.Comparison of the outcomes between open and minimally invasive esophagectomy.Ann Surg,2007,247(2):397-398.
16Wang W,Zhou Y,Feng J,et al.Oncological and surgical outcomes of minimally invasive versus open esophagectomy for esophageal squamous cell carcinoma:a matched-pair comparative study.Int J Clin Exp Med,2015,8(9):15983-15990.
17Yang J,Lyu B,Zhu W,et al.A retrospective cohort comparison of esophageal carcinoma between thoracoscopic and laparoscopic esophagectomy and open esophagectomy.Zhonghua Wai Ke Za Zhi,2015,53(5):378-381.
18Zhu Z,Chen H,Yu W,et al.Number of negative lymph nodes is associated with survival in thoracic esophageal squamous cell carcinoma patients undergoing three-field lymphadenectomy.Ann Surg Oncol,2014,21(9):2857-2863.
19Alline M,Bertrand MM,Colombo PE,et al.Lymph node dissection:what for?From esophagus to rectum:surgical and lymph node related prognostic factors.Bull Cancer,2014,101(4):368-372.
20Ye T,Sun Y,Zhang Y,et al.Three-field or two-field resection for thoracic esophageal cancer:a meta-analysis.Ann Thorac Surg,2013,96(6):1933-1941.
21Hsu PK,Huang CS,Wang BY,et al.The prognostic value of the number of negative lymph nodes in esophageal cancer patients after transthoracic resection.Ann Thorac Surg,2013,96(3):995-1001.
22Baba Y,Watanabe M,Shigaki H,et al.Negative lymph-node count is associated with survival in patients with resected esophageal squamous cell carcinoma.Surgery,2013,153(2):234-241.
23Peyre CG,Hagen JA,Demeester SR,et al.The number of lymph nodes removed predicts survival in esophageal cancer:an international study on the impact of extent of surgical resection.Ann Surg,2008,248(4):549-556.
24Butler N,Collins S,Memon B,et al.Minimally invasive oesophagectomy:current status and future direction.Surg Endosc,2011,25(7):2071-2083.
25Nakata K,Nagai E,Ohuchida K,et al.Outcomes of cervical end-toside triangulating esophagogastric anastomosis with minimally invasive esophagectomy.World J Surg,2015,39(5):1099-1104.
26Zhou C,Ma G,Li X,et al.Is minimally invasive esophagectomy effective for preventing anastomotic leakages after esophagectomy for cancer?A systematic review and meta-analysis.World J Surg Oncol,2015,13(1):1-10.
2Enzinger PC,Mayer RJ.Esophageal cancer.N Engl J Med,2003,349(23):2241-2252.
3毛友生,赫捷,高树庚,等.我国食管癌外科治疗目前存在的热点争议与未来研究方向.中华胃肠外科杂志,2015,18(9):851-854.
4Pennathur A,Luketich JD.Resection for esophageal cancer:strategies for optimal management.Ann Thorac Surg,2008,85(2):S751-S756.
5Moher D,Liberati A,Tetzlaff J,et al.Preferred reporting items for systematic reviews and meta-analyses:The PRISMA statement.Int J Surg,2009,7(9):889-896.
6Stang A.Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in metaanalyses.Eur J Epidemiol,2010,25(9):603-605.
7孟庆江.微创Mc Keown与Ivor-Lewis手术治疗中下段食管癌临床分析.中国医学创新,2016,13(1):17-20.
8梅闪闪,刘继先,吴昊,等.微创荷包钳法Ivor-Lewis术与Mc Keown术治疗中下段食管癌的近期疗效分析.重庆医科大学学报,2016,41(1):89-93.
9Zhai C,Liu Y,Li W,et al.A comparison of short-term outcomes between Ivor-Lewis and Mc Keown minimally invasive esophagectomy.J Thorac Dis,2016,7(12):2352-2358.
10吴汉然,解明然,柳常青,等.微创Ivor-Lewis术与Mc Keown术治疗胸中下段食管癌近期疗效比较.中华胸心血管外科杂志,2014,30(11):649-652.
11林济红,康明强,林江波,等.胸腹腔镜联合食管癌Ivor-Lewis术与Mc Keown术近期疗效比较.中华胃肠外科杂志,2014,17(9):888-891.
12Maas KW,Cuesta MA,Henegouwen MIVB,et al.Quality of life and late complications after minimally invasive compared to open esophagectomy:Results of a randomized trial.World J Surg,2015,39(8):1-8.
13Zhang ZM,Wang Y,Gao YS,et al.Minimally invasive esophagectomy for esophageal carcinoma:clinical analysis of 160cases.Zhonghua Wei Chang Wai Ke Za Zhi,2012,15(9):934-937.
14Mei X,Xu M,Guo M,et al.Minimally invasive Ivor-Lewis oesophagectomy is a feasible and safe approach for patients with oesophageal cancer.ANZ J Surg,2016,86(4):274.
15Smithers BM,Gotley DC,Martin I,et al.Comparison of the outcomes between open and minimally invasive esophagectomy.Ann Surg,2007,247(2):397-398.
16Wang W,Zhou Y,Feng J,et al.Oncological and surgical outcomes of minimally invasive versus open esophagectomy for esophageal squamous cell carcinoma:a matched-pair comparative study.Int J Clin Exp Med,2015,8(9):15983-15990.
17Yang J,Lyu B,Zhu W,et al.A retrospective cohort comparison of esophageal carcinoma between thoracoscopic and laparoscopic esophagectomy and open esophagectomy.Zhonghua Wai Ke Za Zhi,2015,53(5):378-381.
18Zhu Z,Chen H,Yu W,et al.Number of negative lymph nodes is associated with survival in thoracic esophageal squamous cell carcinoma patients undergoing three-field lymphadenectomy.Ann Surg Oncol,2014,21(9):2857-2863.
19Alline M,Bertrand MM,Colombo PE,et al.Lymph node dissection:what for?From esophagus to rectum:surgical and lymph node related prognostic factors.Bull Cancer,2014,101(4):368-372.
20Ye T,Sun Y,Zhang Y,et al.Three-field or two-field resection for thoracic esophageal cancer:a meta-analysis.Ann Thorac Surg,2013,96(6):1933-1941.
21Hsu PK,Huang CS,Wang BY,et al.The prognostic value of the number of negative lymph nodes in esophageal cancer patients after transthoracic resection.Ann Thorac Surg,2013,96(3):995-1001.
22Baba Y,Watanabe M,Shigaki H,et al.Negative lymph-node count is associated with survival in patients with resected esophageal squamous cell carcinoma.Surgery,2013,153(2):234-241.
23Peyre CG,Hagen JA,Demeester SR,et al.The number of lymph nodes removed predicts survival in esophageal cancer:an international study on the impact of extent of surgical resection.Ann Surg,2008,248(4):549-556.
24Butler N,Collins S,Memon B,et al.Minimally invasive oesophagectomy:current status and future direction.Surg Endosc,2011,25(7):2071-2083.
25Nakata K,Nagai E,Ohuchida K,et al.Outcomes of cervical end-toside triangulating esophagogastric anastomosis with minimally invasive esophagectomy.World J Surg,2015,39(5):1099-1104.
26Zhou C,Ma G,Li X,et al.Is minimally invasive esophagectomy effective for preventing anastomotic leakages after esophagectomy for cancer?A systematic review and meta-analysis.World J Surg Oncol,2015,13(1):1-10.