微创和开放手术治疗食管癌的疗效及预后分析

Analysis of outcomes and prognosis of minimally invasive and open esophagectomy for esophageal carcinoma

关键词:  微创食管切除术  预后  食管癌

Key words:  mininally invasive esophageatomy  survival  esophageal carcinoma

摘要:

目的　比较微创与开放手术治疗食管癌的近远期疗效，分析影响并发症和预后的因素。方法　回顾性分析2014年4月—2016年2月江苏省盐城市第一人民医院205例接受微创食管癌手术患者的围手术期资料和生存资料，并与同期247例行开放食管癌手术患者的资料进行对比，多因素Logistic回归模型分析影响术后并发症的风险因素，多因素Cox回归模型分析影响预后的因素。结果　微创组患者术中出血量、术后住院时间、胸管引流时间等优于开放组，差异有统计学意义。微创McKeown组与开放组手术时间相当，差异无统计学意义，微创Ivor-Lewis组手术时间长于开放组。两组R0切除率、双侧喉返神经旁淋巴结清扫以及淋巴结清扫总数无明显差异。微创组术后并发症发生率低于开放组。多因素Logistic回归分析显示TNM分期、美国麻醉医师协会（American Society of Anesthesiology, ASA）分级、不同术者、手术方式、FEV1%FVC是影响术后并发症的风险因素。微创组术后1、3、5年生存率与常规组无明显差异（863%,585%,444% vs 858%，534%,392%；P>005）。多因素分析显示年龄、TNM分期、分化程度是影响患者预后的独立因素。结论　微创食管癌手术较开放手术可减少术中出血、缩短住院时间和降低术后并发症，远期疗效与常规手术相当。

Abstract:

Objective　To investigate the short-term and long-term efficacy of minimally invasive and open esophagectomy in the treatment of patients with esophageal cancer, and to analyze the factors affecting complications and prognosis. Methods　The perioperative and survival data of 205 patients with esophageal cancer who underwent minimally invasive esophagectomy（MIE group) between April 2014 and February 2016 in the First Peoples Hospital of Yancheng and 247 patients who underwent open esophagectomy（open group) during the same period were retrospectively analyzed and compared. The multiple logistic regression model was used to analyze the risk factors affecting postoperative complications.The Cox regression analysis model was used to evaluate the factors affecting the prognosis. Results　The intraoperative blood loss, postoperative hospital stay and chest tubes draining were better in the MIE group than those in the open group, and the differences were statistically significant.The operation time was not statistically different between McKeown MIE group and open group, whereas the MIE Ivor-Lewis group had a longer operation time than that in the open group .The R0 resection rate, bilateral recurrent laryngeal nerve lymph node harvested and total lymph node retried were not significantly different between the two groups. Compared with open group, MIE group was associated with a lower overall incidence of postoperative complications.Multivariate Logistic regression analysis showed that the TNM, American Society of Anesthesiology（ASA）, different surgeon,operation method, and FEV1%FVC were related to postoperative complications. The overall 1, 3, 5-year survival rates were 863%, 585%,444% in the minimally invasive group and 858%，534%, 392% in the open group（P>005）.Multivariate Cox regression analysis revealed that age, TNM staging and differentiated degree were independent prognostic factors. Conclusion　Compared with open surgery, minimally invasive esophagectomy can reduce intraoperative blood loss, shorten length of hospital stay and reduce postoperative complications, and its long-term survival is comparable to that of conventional surgery.