| Objective: To investigate whether minimally invasive esophagectomy(MIE) is a safe and effective way for patients with resectable esophageal cancer by comparing the short-term quality of life(QOL) after minim-ally invasive esophagectomy or open esophagectomy(OE).Methods: A total number of 104 patients who underwent esophage ctomy by the sole surgical group of the Fourth Hospital of Hebei Medica l University from January 2013 to March 2014 were enrolled in this stu dy. These patients were divided into two groups(the group of MIE and the group of OE).There were 75 patients in the MIE group which con tained 46 men and 29 women. The median age of the MIE group was 60(59.68±9.25).The patients in MIE group followed minimally invasi ve esophagectomy, in which 13 ones followed the dissection of esophag us, tumor and lymph nodes under thoracoscopic, gastric mobilization and lymphadenectomy by laparoscopy, thoracic esophagogastrostomy in the rig ht-sided thorax after resection of esophageal cancer, jejunostomy and 62 ones followed the dissection of esophagus, tumor and lymph nodes und er thoracoscopic, gastric mobilization and lymphadenectomy by laparosco py, cervical esophagogastrostomy in the left-side after resection of esoph-a gial cancer, jejunostomy. There were 29 patients in the OE group whi ch contained 18 men and 11 women. The median age of the OE group was 61(61.17±5.71).The patients in OE group followed open esophage ctomy, in which 3 ones followed the dissection of esophagus, tumor an d lymph nodes under the right incision of posterior-lateral chest wall, ga stric mobilization and lymphadenectomy under the middle abdominal in cision, esophagogastrostomy in the right-sided thorax after resection of esophageal cancer, jejunostomy and 26 ones followed the dissection of esophagus, tumor and lymph nodes under the right incision of posterior-l ateral chest wall, gastric mobilization and lymphadenectomy under the m iddle abdominal incision, cervical esophagogastrostomy in the left-side after resection of esophageal cancer, jejunostomy. Three scoring scales of quality of life were used to evaluate QOL before the operation and in the first month, the third month, the sixth month and the twelfth mo nth after MIE or OE, which consist of Karnofshy performance scale(K PS), The European Organization for Research and Treatment questionnair e QLQ C-30(EORTC QLQC-30) and Esophageal cancer supplement scal e(OES-18). Statistical method: For measurement data, t-test was applied to the data that conformed to normal distribution and homogeneity varia nce, and Wilcoxon rank sum test was applied to the data that did not conform to normal distribution and homogeneity variance. For enumerati on data, Chi-square distribution was used. SPSS 13.0 was used to statis tical analysis and P<0.05 was considered for significant differences(α=0.05).Results:1 In MIE group, there were 75 patients, in which 67 was followed, 8 was lost to follow-up, and in which 5 was dead in the first year(1 was dead of interstitial pneumonia in the seventh day after surgery). In OE group, there were 29 patients, in which 25 was followed, 4 was l ost to follow-up, in which 7 was dead in the first year(1 was dead of empyema in the fourth day after surgery).The MIE group was higher t han the OE group in one-year survival rate(92.54% vs.72.00%).2 No significant differences between the two groups were observed in sex ratio(P=0.945), age(P=0.387), Postoperative pathological stage(P=0.085), number of dissected lymph nodes(P=0.980), respiration supporting(P=0.981), the incidence of chylothorax(P=0.662), esophagogastric anast omotic fistula(P=0.909), operative duration(P=0.072). Significant differen ces between the two groups were observed in blood loss(158.53±91.07ml vs.228.97±109.33 ml, Z=-3.261,P=0.001), The incidence of postoperative pneumonia(33.33% vs.58.62%, c2=5.555,P=0.018).3 No significant differences between the two groups were observed in KPS before the operation(90 vs.90, Z=-0.640,P=0.522>0.05), However, the MIE group was higher than the OE group on KPS in the first m onth(80 vs.70, Z=-2.903,P=0.004<0.05), the third month(90 vs.80, Z=-2.739,P=0.006<0.05), the sixth month(90 vs.80, Z=-2.532,P=0.007<0.05) and the twelfth month(90 vs.80, Z=-2.887,P=0.004<0.05) after MIE or OE.4 All the QLQC-30 measures did not show significant differences be tween the two groups before the operation. However, the MIE group wa s better than the OE group on QLQC-30 in first month( general QO L(P<0.001), physical(P<0.001), role functioning(P<0.001), emotion al(P=0.011), social functioning(P<0.001), fatigue(P=0.001),pain(P<0.001), dyspnoea(P=0.001), economic difficulties(P=0.039)),the third month(general QOL(P<0.001), physical(P<0.001), role functioning(P<0.001), cognitive(P=0.024), emotional(P=0.030), social functionin g(P<0.001), fatigue(P<0.001),pain(P<0.001), dyspnoea(P=0.004), anorexia(P=0.005)),the sixth month(general QOL(P<0.001), role fu nctioning(P=0.001), social functioning(P<0.001), fatigue(P=0.012),pain(P<0.001), economic difficulties(P=0.042)) and the twelfth mon th(general QOL(P<0.001), role functioning(P=0.035), pain(P=0.020)) after MIE or OE..5 All the OES-18 measures did not show significant differences bet ween the two groups before the operation. However, the MIE group w as better than the OE group on OES-18 in first month(dysphagia(P=0.003),deglutition(P<0.001), pain(P<0.001), eating(P<0.001), t aste(P<0.001), trouble talking(P=0.001), trouble coughing(P=0.020) the third month(dysphagia(P=0.016),deglutition(P=0.005), pai n(P<0.001), eating(P<0.001), taste(P<0.001), dry mouth(P=0.010), trouble talking(P<0.001), trouble coughing(P=0.006)),the sixth month(deglutition(P=0.002), pain(P<0.001), eating(P=0.001), taste(P=0.003)) and the twelfth month(deglutition(P=0.007), pain(P<0.001), ta ste(P=0.003)) after MIE or OE..Conclusion:1 The MIE group was higher than the OE group in one-year surviva l rate. The MIE group was no higher than the OE group in postoperati ve complication.2 The MIE group was no worse than the OE group in the scope an d number of the lymph nodes dissection. The MIE caused less impact on talking than the OE, because of better protection for recurrent laryngeal nerve under the thoracoscope.3 The MIE group was better than the OE group in the short-term q uality of life after minimally invasive esophagectomy or open esophagec tomy. |
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