| Objective: Esophagectomy represents the standard in the treatment of resectable esophageal carcinoma. Minimally invasive Ivor-Lewis esophagectomy of intrathoracic esophagogastric anastomosis(MIE-chest) plays an important role in treatment of middle or lower esophageal carcinoma.However, because of the relatively high risk and mortality of anastomotic leak associated with radical surgery for esophageal cancer, MIE-chest has not become widespread at the moment. The aim of this study was to evaluate the safety and feasibility of MIE-chest techniques and to compare the outcomes of minimally invasive esophagectomy with open esophagectomy.Methods: We retrospectively evaluated 538 patients perioperative data with middle or lower esophageal carcinoma who received Ivor-Lewis esophagectomy in our center between March2011 and December 2014. Of those 538 patients, 184 underwent MIE(MIE group) and 354 underwent open Ivor-Lewis esophagectomy(OE group). The perioperative data, operational factors, postoperative complications, and short-term follow-up data were compared.Perioperative data were compared, including age,histopathology,underlying disease.Operational factors were compared, including operation time,the volume of blood transfusion, R1 resections, number of harvested lymph nodes. Postoperative complications were compared as well, including anastomotic leak, trachyphonia, pulmonary morbidity rate and so on. All of the patients received a follow-up every 3 months,during which,the clinical variables of two groups were compared, including anastomosis strictures, gatroesophageal reflux, tumor recurrence and metastasis occurred on postoperative were compared between MIE group and OE group.Results:The two groups were similar in terms of age,histopathology and underlying disease.The MIE approach was associated with a significant increase in operative time(7.35±3.31 h in MIE group versus 4.63±2.88 h in OE group,p<0.05). The surgical blood transfusion of the MIE group was less than that of the OE group(0.80±0.25 U in MIE group versus 1.89±2.23 U in OE group,p =0.003),There were no significant differences between the two groups in R1resections(p >0.05) and number of harvested lymph nodes(15.66±1.39 per patient in MIE group versus 15.42±0.09 per patient in OE group,p >0.05). Similarly, the two groups were not significantly different with regard to the right recurrent nerve lymph nodes(3.03±0.51 per patient in MIE group versus 2.88±1.04 per patient in OE group,p >0.05) or left recurrent nerve lymph nodes(2.63±0.54 per patient in MIE group versus 2.92±4.17 per patient in OE group,p >0.05). There was no significantly different in the incidence of renal adverse events between the two groups(p >0.05). There was no significant difference in the arrhythmia rate between the two groups(6.5% in the MIE group versus 7.6% in the OE group, p >0.05).Additionally, pulmonary morbidity, the rate of leak, and 30-day mortality were not significantly different between MIE and OE groups. Patients in two groups received a follow-up untill December 2015. Morbidities including anastomosis strictures,gatroesophageal reflux were not significantly different between MIE and OE groups as well.The two groups did not differ in terms of tumor recurrence and metastasis. Three anastomosis recurrences occurred in the MIE group and eight cases in the OE group. The overall survival rate at 1 year stratified by pathologic stage at MIE was 84.8%(stage 1), 75.2%(stage II),,45.5%(stage III), and 21.4%(stage IV). The 2-year survival rate stratified by pathologic stage at MIE was 81.8%(stage 1), 70.1%(stage II),36.4%(stage III), and 14.3%(stage IV).The overall survival rate at 1 year stratified by pathologic stage at OE was 84.1%(stage 1),81.1%(stage II), 48.8%(stage III), and 28.6%(stage IV). The 2-year survival rate stratified by pathologic stage at OE was 79.5%(stage 1), 70.8%(stage II),39.5%(stage III), and 17.9%(stage IV).There were no significant differences in 1-year survival rate(66.3% in the MIE group versus 64.8% in the OE group, p>0.05) and 2-year survival rate(60.9% in the MIE group versus 57.6% in the OE group, p>0.05) between the two groups.Conclusion: We found that MIE is almost equivalent to open esophagectomy in oncological resection and the number of total lymph nodes dissected,there were no significant differences between the two treatment groups in terms of postoperative complications. Follow-up showed that morbidities including anastomosis strictures, gatroesophageal reflux, and tumor recurrence and metastasis were not significantly different between MIE and OE groups. This technique is a safe,feasible and effective approach for patients with middle or lower esophageal. Therefore, a multicenter,prospective, randomized, controlled trial comparing MIE with open esophagectomy are necessary in order to evaluate long-term outcomes of this operation. |
PDF Full Text Request