Clinical analysis of minimally invasive McKeown esophagectomy in a single center by a single medical group

Abstract

Objective: McKeown esophagectomy followed by cervical and abdominal procedures has been commonly used for invasive esophageal carcinoma. This minimally-invasive operative procedure in the lateral prone position has been considered to be the most appropriate method. We describe our experiences in minimally invasive McKeown esophagectomy (MIME) for esophageal cancer. Methods: Between March 2016 and February 2018, a total of 82 patients underwent MIME by a single group in our department (a single center). All procedure, operation, oncology, and complication data were reviewed. Results: All MIME procedures were completed successfully, with no conversions to open surgery. The median operative time was 260 min, and median blood loss was 100 ml. The average number of total harvested lymph nodes was 20.1 in the chest and 13.5 in the abdomen. There were no deaths within 30 postoperative days. Twenty cases (24.4%) developed postoperative complications, including anastomotic leak in 4 (4.9%), single lateral recurrent nerve palsy in 4 (4.9%), bilateral recurrent nerve palsy in 1 (1.2%), pulmonary problems in 3 (3.7%), chyle leak in 1 (1.2%), and other complications in 7 (including pleural effusions in 4, incomplete ileus in 2, and neck incision infection in 1; 8.54%). Average postoperative hospitalization time was 12 d. Blood loss, operation time, morbidity rate, and the number of harvested lymph nodes were analyzed by evaluating learning curves in different periods. Significant differences were found in operative time (P=0.006), postoperative hospitalization days (P=0.015), total harvested lymph nodes (P=0.003), harvested thoracic lymph nodes (P=0.006), and harvested abdominal lymph nodes (P=0.022) among different periods. Conclusions: Surgical outcomes following MIME for esophageal cancer are safe and acceptable. The MIME procedure for stages I and II could be performed proficiently and reached an experience plateau after approximately 25 cases.

摘要

目的

颈胸腹联合三切口食管癌切除术(McKeown)被 广泛应用于食管癌的治疗。侧俯卧位的全腔镜食 管癌切除术目前被认为是合适的治疗方式。本文 回顾性分析了本中心的食管癌全腔镜手术的经 验。

创新点

目前全腔镜食管癌手术在国内仍是少数大的医疗 中心开展,对于多数医院仍未能开展。本研究单 中心单医疗组全腔镜食管癌病例分析以及学习 曲线,目前国内类似经验总结尚不多,对于该术 式推广有一定指导意义。

方法

在2016 年4 月至2018 年2 月之间,共82 例食管 癌病人在我中心由单医疗组进行全腔镜食管癌 切除手术,手术方式、临床资料、手术、病理、 并发症等资料被回顾性分析。全部的腔镜手术全 部被成功完成,无一例术中转为开放手术。手术 时间为260 分钟,术中出血100 毫升。胸部和腹 部的淋巴结清扫枚数分别为20.1 和13.5 枚。术后 30 天内未出现死亡病例。总并发症率为24.4%, 包括吻合口瘘4 例(4.9%),喉返神经损伤5 例 (6.1%),肺部感染3 例(3.7%),乳糜胸1 例 (1.2%),胸腔积液4 例(4.9%),不全肠梗阻 2 例(2.5%),颈部切口感染1 例(1.2%)。术 后平均住院天数12 天。根据学习曲线,我们分 析了不同阶段的出血量、手术时间、并发症率、 淋巴结清扫数量等数据。不同阶段的手术时间 (P=0.006)、术后住院天数(P=0.015)、总淋 巴结清扫数(P=0.003)、胸腔内淋巴结清扫数 (P=0.006)和腹腔内淋巴结清扫数(P=0.022) 均有统计学差异。

结论

全腔镜食管癌切除手术被认为是安全的、合适的。 对于I 期、II 期的食管癌病人,随着手术例数的 积累手术技巧会更熟练,并在25 例左右到达平 台期。