Thoracolaparoscopic esophagectomy and open surgery for different pathological stages of esophageal cancer: a comparison of short-term efficacy

Yuan LI; Haoming SHI; Cheng ZHANG; Dan CHEN; Qingchen WU

doi:10.16016/j.1000-5404.202008031

您当前的位置：

首页 >

文章列表页 >

Thoracolaparoscopic esophagectomy and open surgery for different pathological stages of esophageal cancer: a comparison of short-term efficacy

Clinical Medicine | 更新时间：2026-01-09

- Thoracolaparoscopic esophagectomy and open surgery for different pathological stages of esophageal cancer: a comparison of short-term efficacy
- Journal of Third Military Medical University Vol. 42, Issue 24, Pages: 2419-2425(2020)
- 作者机构：
  
  400016 重庆，重庆医科大学附属第一医院胸心外科
- 作者简介：
- 基金信息：
- DOI：10.16016/j.1000-5404.202008031
  CLC： R181.32;R730.56;R735.1
- Received：04 August 2020，
  
  Revised：2020-09-17，
  
  Published：30 December 2020
- 稿件说明：
移动端阅览
Yuan LI, Haoming SHI, Cheng ZHANG, et al. Thoracolaparoscopic esophagectomy and open surgery for different pathological stages of esophageal cancer: a comparison of short-term efficacy[J]. Journal of Third Military Medical University, 2020, 42(24): 2419-2425.
DOI：

Yuan LI, Haoming SHI, Cheng ZHANG, et al. Thoracolaparoscopic esophagectomy and open surgery for different pathological stages of esophageal cancer: a comparison of short-term efficacy[J]. Journal of Third Military Medical University, 2020, 42(24): 2419-2425. DOI： 10.16016/j.1000-5404.202008031.

摘要

目的

探讨胸腹腔镜联合微创手术与传统开放手术对不同病理分期食管癌短期预后的影响，为不同病理分期食管癌的手术选择提供依据。

方法

回顾性分析我科2017年1月至2018年12月间收治并行食管癌根治术的280例患者的临床资料，依据手术方式分为微创组和开放组。比较两组的围术期预后、术后并发症及不同病理分期行两种手术方式的短期疗效。

结果

微创组81例，开放组199例。术后病理诊断为0期8例，Ⅰ期43例，Ⅱ期103例，Ⅲ期106例，Ⅳa期20例。与开放组相比，微创组手术时间明显长于开放组(

0.05)，术中出血量明显少于开放组(

0.05)；两组病例术后住院时间无统计学差异(

0.05)，但微创组术后恢复饮食所需时间更长(

0.05)。两组病例总的术后并发症发生率无明显差异(

0.05)，但微创组更容易发生吻合口瘘(

0.05)，开放组更容易出现肺部感染及胸腔积液(

0.05)。在不同病理分期食管癌患者中，微创组的手术时间普遍更长(

=20.231，

0.05)，而病理分期对于手术时间无明显影响(

=1.300

0.05)。病理分期与手术方式对于患者术后恢复饮食时间、术后住院时间有共同作用(交互作用的主效应，

0.05)。相较于其它分期患者，0期和Ⅳ期患者术后恢复饮食时间、术后住院时间均更短(

0.05)。对于Ⅳ期，无法行根治性切除、仅行R0期切除患者，微创组更能有效缩短术后恢复饮食时间及术后住院时间(

0.05)。

结论

胸腹腔镜联合微创食管癌根治术在减少术中出血、降低肺部并发症发生率等方面具有明显优势。对于非R0切除的患者，微创手术更利于患者术后快速恢复，从而得以尽快进行术后继续治疗，对延长晚期患者的生活质量、生存期限具有重要意义。

Abstract

Objective

To investigate the effect of minimally invasive thoracolaparoscopic or open esophagectomy on the short-term prognosis of esophageal cancer with different pathological stages and provide clinical experience for surgical selection for the patients.

Methods

A retrospective analysis was performed on the clinical data of 280 patients undergoing radical resection due to esophageal cancer in our department from January 2017 to December 2018. According to the surgical approaches

they were divided into minimal invasive group (MI

=81) and open surgery group (OS

=199). The perioperative prognosis

postoperative complications

and short-term efficacy of 2 surgical methods for different pathological stages were compared between the 2 groups.

Results

For the totally 280 patients

postoperative pathological diagnosis identified 8 cases of stage 0

43 cases of stage Ⅰ

103 cases of stage Ⅱ

106 cases of stage Ⅲ and 20 cases of stage Ⅳ. The MI group had a significantly longer operation time and less intraoperative blood loss when compared with the OS group (both

0.05). Though there was no statistical difference in postoperative hospital stay between the 2 groups (

0.05)

the time needed for postoperative diet recovery was obviously longer in the MI group (

0.05). The total incidences of postoperative complications were similar (

0.05)

but the patients of the MI group were prone to anastomotic fistula (

0.05)

while those of the other group to pulmonary infection and pleural effusion (

0.05). Among the patients with different pathological stages of esophageal cancer

the operation

time in the MI group was generally longer than that in the OS group (

=20.231

0.05)

while the pathological stage did not affected the operation time (

=1.300

0.05). The pathological stage and surgical approach had a joint effect on the postoperative diet recovery time and hospital stay time (main effect of interaction

0.05). The patients with 0 or Ⅳ stage had a shorter recovery time than those with other stages (

0.05). For the Ⅳ stage patients who could not undergo radical resection but only underwent R0 resection

the minimally invasive surgery was more effective in shortening the postoperative diet recovery time and hospital stay time (

0.05).

Conclusion

Compared with OS

thoracolaparoscopic surgery has obvious advantages in reducing intraoperative bleeding and incidence of pulmonary complications. For the patients who cannot undergo radical (R0) resection

minimally invasive surgery can accelerate postoperative recovery

which is of great significance in performing continuous treatment as soon as possible

promoting the quality of life and prolonging the survival period of the patients.

关键词

Keywords

references

AJANI J A, D'AMICO T A, BENTREM D J, et al . Esophageal andesophagogastric 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.

于振涛.食管癌外科治疗现状及争议热点[J].中华肿瘤杂志, 2016, 38(09): 646-649.

YU Z T. Current status of surgical treatment of esophageal carcinoma and related hot issues[J]. Chin J Oncol, 2016, 38(09): 646-649.

林涛, 解明然, 马冬春.微创与开放Ivor Lewis食管切除术后急慢性疼痛对比研究[J].中华肿瘤防治杂志, 2019, 26(11): 784-789.

LIN T, XIE M R, MA D C. Acute and chronic pain between minimally invasiveivor iewis esophagectomy and open ivor lewis esophagectomy[J]. Chin J Cancer Prev Treat, 2019, 26(11): 784-789.

蔡华荣, 羽平, 周洪, 等.胸腹腔镜联合食管癌根治术与传统食管癌根治术同期临床对照研究[J].第三军医大学学报, 2014, 36(20): 2142-2144.

CAI H R, YU P, ZHOU H, et al . Radical resection of esophagus carcinoma by open versus minimally invasive approaches: a clinical study of 108 cases[J ] . J Third Mil Med Univ, 2014, 36(20): 2142-2144.

RICE T W, ISHWARAN H, FERGUSON M K, et al . Cancer of the esophagus andesophagogastric junction: an eighth edition staging primer[J ] . J Thorac Oncol, 2017, 12(1): 36-42. DOI: 10.1016/j.jtho.2016.10.016.

肖蔼杰, 张志辉, 林植楷, 等.胸腹腔镜联合手术在食管癌治疗中的应用效果探讨[J].中国医学创新, 2015, 12(16): 136-138.

XIAO A J, ZHANG Z H, LIN Z K, et al . To explore the application effect of chest laparoscopic combined operation in the treatment of esophageal cancer[J ] . Med Innov Chin, 2015, 12(16): 136-138.

郑晓东, 张卫民, 侯建彬.胸腹腔镜联合微创术与开放手术治疗食管癌的临床效果比较[J].中国临床新医学, 2019, 12(10): 1108-1112.

ZHENG X D, ZHANG W M, HOU J B. Comparison of the clinical effects between minimally invasive surgery thoracolaparoscopic esophagectomy and open esophagectomy on treatment of esophageal carcinoma[J]. Chin J New Clin Med, 2019, 12(10): 1108-1112.

MU J W, GAO S G, XUE Q, et al . Updated experiences with minimally invasive McKeown esophagectomy for esophageal cancer[J ] . World J Gastroenterol, 2015, 21(45): 12873-12881. DOI: 10.3748/wjg.v21.i45.12873.

陈亮, 王武军, 蔡瑞君.胸腔镜腹腔镜联合手术与开放手术治疗食管癌的Meta分析[J].中华胃肠外科杂志, 2012(06): 603-607.

CHEN L, WANG W J, CAI R J.Thoracolaparoscopic esophagectomy versus open esophagectomy: A meta-analysis of outcomes[J]. Chin J Gastrointest Surg, 2012(6): 603-607.

于洋复, 赵文刚, 刘仁杰.胸腹腔镜联合手术在食管癌治疗中的临床效果及安全性[J].中国医药指南, 2020, 18(09): 141-142.

YU Y F, ZHAO W G, LIU R J.Clinical effect and safety of combined thoracoscopic surgery in the treatment of esophageal cancer[J]. Guide Chin Med, 2020, 18(9): 141-142.

柳林, 张勇, 王霄霖, 等. pT1b期食管鳞状细胞癌开放手术与微创食管切除术后预后分析[J].中国胸心血管外科临床杂志, 2020, 27(7): 1-8.

LIU L, ZHANG Y, WANG X L, et al . Prognostic analysis of pT1b esophageal squamous cell carcinoma after open or minimally invasive esophagectomy[J ] . Chin J Clin Thorac Cardiov Surg, 2020, 27(7): 1-8.

YIBULAYIN W, ABULIZI S, LV H, et al . Minimally invasive oesophagectomy versus open esophagectomy for resectable esophageal cancer: a meta-analysis[J ] . World J Surg Onc, 2016, 14: 304. DOI: 10.1186/s12957-016-1062-7.

孙超, 石维平, 吕小夏, 等.三切口食管癌切除术:胸腔镜与开放手术的术后并发症分析[J].中华腔镜外科杂志(电子版), 2016, 9(6): 354-357.

SUN C, SHI W P, LYU XX, et al . Analysis of postoperative complications for McKeown esophagectomy: minimally invasive versus open esophagectomy[J ] . Chin J Laparosc Surg Electron Ed, 2016, 9(6): 354-357.

SEESING M F J, GISBERTZ SS, GOENSE L, et al . A propensity score matched analysis of open versus minimally invasivetransthoracic esophagectomy in the Netherlands[J ] . Ann Surg, 2017, 266(5): 839-846. DOI: 10.1097/sla.0000000000002393.

王文凭, 何松林, 杨玉赏, 等.食管癌微创外科手术的现状与思考[J].中国胸心血管外科临床杂志, 2018, 25(4): 338-344.

WANG W P, HE S L, YANG Y S, et al . Development and future of the minimally invasiveesophagectomy for esophageal cancer[J ] . Chin J Clin Thorac Cardiovasc Surg, 2018, 25(4): 338-344.

林涛, 解明然, 马冬春.微创与开放Ivor Lewis食管切除术后急慢性疼痛对比研究[J].中华肿瘤防治杂志, 2019, 26(11): 784-789.

LIN T, XIE M R, MA D C. Acute and chronic pain between minimally invasiveivor iewis esophagectomy and open Ivor Lewis esophagectomy[J]. Chin J Cancer Prev Treat, 2019, 26(11): 784-789.

陈保富, 朱成楚, 王春国, 等.胸腔镜腹腔镜联合手术与开放手术治疗食管癌的同期临床对照研究[J].中华外科杂志, 2010, 48(16): 1206-1209.

CHEN B F, ZHU C C, WANG C G, et al . Clinical comparative study ofminimally invasive esophagectomy versus open esophagectomy for esophageal carcinoma[J ] . Chin J Surg, 2010, 48(16): 1206-1209.

KAUPPI J, RÄSÄNEN J, SIHVO E, et al . Open versus minimally invasive esophagectomy: clinical outcomes for locally advanced esophageal adenocarcinoma[J ] . Surg Endosc, 2015, 29(9): 2614-2619. DOI: 10.1007/s00464-014-3978-8.

TAKEUCHI H, MIYATA H, GOTOH M, et al . a risk model foresophagectomy using data of 5354 patients included in a Japanese nationwide web-based database[J ] . Ann Surg, 2014, 260(2): 259-266. DOI: 10.1097/sla.000000000 0000644.

BIERE SS, VAN BERGE HENEGOUWEN M I, MAAS K W, et al . Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial[J ] . Lancet, 2012, 379(9829): 1887-1892. DOI: 10.1016/s0140-6736(12)60516-9.

LI B, YANG Y, SUN Y, et al . Minimally invasive esophagectomy for esophageal squamous cell carcinoma-Shanghai Chest Hospital experience[J ] . J Thorac Dis, 2018, 10(6): 3800-3807. DOI: 10.21037/jtd.2018.06.75.

LV L, HU W, REN Y, et al . Minimally invasive esophagectomy versus open esophagectomy for esophageal cancer: a meta-analysis[J ] . Onco Targets Ther, 2016, 9: 6751-6762. DOI: 10.2147/ott.s112105.

张卫国, 李勉, 单言歌, 等.食管癌术后颈部吻合口瘘的危险因素分析[J].中国胸心血管外科临床杂志, 2020, 27(03): 303-307.

ZHANG W G, LI M, SHAN Y G, et al . Analysis of risk factors of cervical anastomotic leakage after esophageal cancer operation[J ] . Chin J Clin Thorac Cardiov Surg, 2020, 27(3): 303-307.

MO R, CHEN C, PAN L, et al . Cervical or thoracic anastomosis for patients with cervicothoracic esophageal squamous cell carcinoma[J ] . Ann Transl Med, 2018, 6(11): 202. DOI: 10.21037/atm.2018.05.19.

BIERE S S A Y, MAAS K W, CUESTA M A, et al . Cervical or thoracic anastomosis after esophagectomy for cancer: a systematic review and meta-analysis[J ] . Dig Surg, 2011, 28(1): 29-35. DOI: 10.1159/000322014.

张彤, 马永富, 李云婧, 等.微创Ivor-Lewis术与McKeown术治疗T3期中下段食管癌的疗效比较[J].解放军医学院学报, 2020, 41(1): 60-63.

ZHANG T, MA Y F, LI Y J, et al . Outcomes of minimally invasiveesophagectomy for patients with stage T3 tumors located on middle or lower thoracic esophagus: Ivor-Lewis versus McKeown[J ] . Acad J Chin PLA Med Sch, 2020, 41(1): 60-63.

DEIDDA S, CRIPPA J, DUCHALAIS E, et al . Hybrid minimally invasive/open approach versus total minimally invasive approach for rectal cancer resection: short-and long-term results[J ] .Int J Colorectal Dis, 2019, 34(7): 1251-1258. DOI: 10.1007/s00384-019-03311-4.

YEROKUN B A, SUN Z F, YANG C F J, et al . Minimally invasive versus openesophagectomy for esophageal cancer: a population-based analysis[J ] . Ann Thorac Surg, 2016, 102(2): 416-423. DOI: 10.1016/j.athoracsur.2016.02.078.

MITZMAN B, LUTFI W, WANG C H, et al . Minimally invasiveesophagectomy provides equivalent survival to open esophagectomy: an analysis of the national cancer database[J ] . Semin Thorac Cardiovasc Surg, 2017, 29(2): 244-253. DOI: 10.1053/j.semtcvs.2017.03.007.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Development of a prediction model for chemotherapy and immunotherapy response in esophageal squamous cell carcinoma patients using machine learning algorithms

Efficacy of different treatments for progressive subdural effusion after decompressive craniectomy for craniocerebral injury

Application and prospect of robotic surgical system in vascular surgery

Clinical efficacy and safety of ruxolitinib in treatment of chronic graft versus host disease

Diagnosis and management of idiopathic scoliosis: history and future

Related Author

ZHANG Xiaoqin

LIU Jie

LI Tongxin

WU Yi

HE Ping

WU Wei

CHEN Jincheng

Enren WANG

Related Institution

Department of Thoracic Surgery， First Affiliated Hospital， Army Medical University （Third Military Medical University）

Department of Digital Medicine， College of Biomedical Engineering and Medical Imaging， Army Medical University （Third Military Medical University）

Department of Cardiac Surgery， First Affiliated Hospital， Army Medical University （Third Military Medical University）

Department of Vascular Surgery, First Affiliated Hospital, Army Medical University (Third Military Medical University)

Department of Orthopaedics, First Affiliated Hospital, Army Medical University (Third Military Medical University)

⁰