Objective: To evaluate the perioperative period and long-term effects of minimally invasive gasless laparoscopic transhiatal esophagectomy (LTE) and minimally invasive combined thoracoscopic and laparoscopic esophagectomy (CTLE) for stageⅠ-Ⅲ cervical esophageal cancer. Methods: The clinical data of 158 consecutive patients with cervical esophageal cancer stageⅠto Ⅲ who underwent minimally invasive CTLE or LTE esophagectomy in the Department of Thoracic Surgery, Beijing Tongren Hospital from January 2008 to December 2019 were retrospectively analyzed. A total of 40 pairs of cases were matched (40 cases of CTLE and 40 cases of LTE surgery) after using the propensity score matching analysis which aimed to balance the influence of confounding factors between groups, including 43 males and 37 females, aged 51 to 81 (62.5±7.0) years old. The perioperative variables and long-term outcomes of the two groups were compared. Results: The operation time ((148.0±31.3) min vs (201.3±48.3) min), intraoperative blood loss ((192.6±77.9) ml vs (387.8±112.4) ml), ICU monitoring time (0 day vs 1 day), and the complication rates of postoperative pneumonia (0 vs 15%) and arrhythmia (2.5% vs 20%) were lower in the LTE group than that of in the CTLE group(all P<0.05). The number of lymph node dissections in the CTLE group was higher than that of in the LTE group (21.2±6.1 vs 12.9±4.3, P<0.001). The 3-and 5-year overall survival (OS) rate and disease-free survival (DFS) rate in the LTE group (OS: 53.53% and 34.27%, DFS: 43.62% and 24.89%, respectively) and the CTLE group (OS: 59.48% and 37.29%, DFS: 49.12% and 28.82%, respectively) had no statistical differences (all P>0.05). Conclusion: The LTE group has advantages in reducing operation time, intraoperative bleeding, ICU monitoring time, postoperative incidence of pneumonia and arrhythmia, and its long-term prognosis is comparable to that of the CTLE group.
目的： 比较无气腹腹腔镜下经膈肌裂孔游离食管的颈段食管癌切除术（LTE）与胸、腹腔镜联合食管癌根治术（CTLE）治疗Ⅰ~Ⅲ期颈段食管癌的围手术期及远期疗效。 方法： 回顾性分析北京同仁医院胸外科2008年1月至2019年12月期间的Ⅰ~Ⅲ期颈段食管癌行微创CTLE或LTE术式的连续158例患者临床资料，采用倾向性评分匹配法均衡组间混杂因素的影响后，匹配40对病例（CTLE和LTE术式各40例），其中男43例，女37例，年龄51~81（62.5±7.0）岁，比较两组患者围手术期相关指标（主要包括手术时间、术中出血量、重症监护病房监护时间以及术后肺炎和心律失常等并发症发生率）及远期预后。 结果： LTE组的手术时间［（148.0±31.3）min比（201.3±48.3）min）］、术中出血量［（192.6±77.9）ml比（387.8±112.4）ml］、重症监护病房监护时间（0 d比1 d）以及术后肺炎（0比15%）和心律失常（2.5%比20%）的并发症发生率均低于CTLE组（均P<0.05）；CTLE组淋巴结清扫数目高于LTE组［（21.2±6.1）枚比（12.9±4.3）枚，P<0.001］。LTE组3、5年总体生存率（OS）和无病生存率（DFS）（OS：53.53%和34.27%，DFS：43.62%和24.89%）与CTLE组（OS：59.48%和37.29%，DFS：49.12%和28.82%）相比，差异均无统计学意义（均P>0.05）。 结论： LTE在减少手术用时、术中出血、重症监护病房监护时间和降低术后肺炎、心律失常发生率等方面有优势，其远期预后与CTLE相当。.