Improved Ivor-Lewis Cervical Stapled Esophagogastrostomy via Thorax for Middle Esophageal Carcinoma: An Ambispective Cohort Study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GUXiao-hua ¹ ,  MAOZhi-ming ¹ , MAOWang-shan ¹ , ZHANGTao ¹ , XUBo-tao ¹ , SUNJian ¹ , HUANGHai-sheng ² , ZHAOYang ³

1. Department of Thoracic Surgery, Rugao Boai Hospital, Rugao 226500 Jiangsu, P. R. China;
2. Department of Pathology, Rugao Boai Hospital, Rugao 226500 Jiangsu, P. R. China;
3. Department of Epidemiology and Health Statistics, The Public Health College of Nanjing, Medical University, Nanjing 211166, P. R. China;

Corresponding?author：

MAOZhi-ming, Email: gsmzm@126.com

Keywords：

Esophageal carcinoma; Esophagectomy; Lymphadenectomy; Laparoscopic assistant; Fast track surgery

DOI：

10.7507/1007-4848.20160107

Video：

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Objective To determine if laparoscopic assisted Ivor-Lewis cervical stapled esophagogastrostomy via a minor subaxillary incising enables better perioperative and medium-term outcome than Ivor-Lewis cervical stapled esophagogastrostomy via thorax for middle esophageal carcinoma without intumescent lymphnode of neck. Methods The perioperative and medium-term outcome of a series of 55 patients underwent Ivor-Lewis cervical stapled esophagogas-trostomy via thorax between April 2010 and December 2012 were as a historic cohort (group A, 36 males, 19 females at age of 65±8 years). And 46 patients underwent laparoscopic assisted Ivor-Lewis cervical stapled esophagogastrostomy via a minor subaxillary incising between January 2013 and March 2015 were as a prospective cohort (group B, 31males, 15 females at age of 66±7 years). Perioperative indexes, lymphadenectomy, and result at end of one year following up were compared. Results Compared with group A, there was shorter thoracic operation time (t=5.94, P < 0.05), shorter time of restored anus exhaust (t=2.08, P < 0.05), less pulmonary complication (χ²=3.08, P < 0.05) and less total perioperative complications (χ²=4.30, P < 0.05), shorter postoperative hospital stay (t=3.20, P < 0.05) in the group B. While no statistically significant difference was found between the two group in postoperative morbidity of circulation or digestive and associated with surgical techniques (all P>0.05), lymph node metastasis rate of cervico-thoracic (include cervical paraesophageal) or mediastinum or abdominal cavity (χ²=0.03, 0.15, 0.08, all P>0.05), lymph node ratio (LNR) of cervical thoracic (include cervical paraesophageal) or mediastinum or abdominal cavity (χ²=0.01,0.71, 0.01, all P>0.05), recurrence rate of tumour (χ²=0.04, P>0.05), or survival rate (χ²=0.13, P>0.05) one year after the surgery. Conclusion Laparoscopic assisted Ivor-Lewis cervical stapled esophagogastrostomy via a minor subaxillary incising is a more rational surgery of cervicothoracic and cervical paraesophageal lymph nodes dissection via intrathoracic instead of cervical approach for middle esophageal carcinoma.

Citation： GUXiao-hua, MAOZhi-ming, MAOWang-shan, ZHANGTao, XUBo-tao, SUNJian, HUANGHai-sheng, ZHAOYang. Improved Ivor-Lewis Cervical Stapled Esophagogastrostomy via Thorax for Middle Esophageal Carcinoma: An Ambispective Cohort Study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(5): 453-458. doi: 10.7507/1007-4848.20160107 Copy

1.	冒志明, 顧曉華, 李昌炎, 等. Ivor-Lewis經胸頸部機械吻合術治療中段食管癌的前瞻性研究. 中華消化外科雜志, 2013, 12(10):754-758.
2.	冒志明, 顧曉華, 李昌炎, 等. 頸胸交界部淋巴結轉移特征及清掃價值的前瞻性隊列研究.中國胸心血管外科臨床雜志, 2015, 22(11): 1031-1035.
3.	Kuwano H, Nishimura Y, Oyama Y, et al. Guidelines for diagnosis and treatment of carcinoma of the esophagus April 2012 edited by the Japan Esophageal Society. Esophagu, 2015, 12(1):1-30.
4.	方文濤, 茅騰, 谷志濤. 微創食管癌根治術——優勢與風險. 中華胸心血管外科雜志, 2013, 29(7):392-393.
5.	毛友生, 赫捷, 薛奇, 等. 全國食管癌規范化診治推廣之路. 中華胃腸外科雜志, 2013, 16(9):801-804.
6.	Herbella FA, Del Grande JC, Colleonim R, et al. Anatomical analysis of the mediastinal lymph nodes of normal Brazilian subjects according to the classification of the Japanese Society for Diseases of the Esophagus. J Surg today, 2003, 33(4):249-253.
7.	Lerut T, Nafteux P, Moons J, et al. Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 R0 resection:impact on staging, disease-free survival and outcome: a plea for adaptation TNM classification in upper-half esophageal carcinoma. J Ann Surg, 2004, 240(6):962-974.
8.	Fujita H, Sueyoshi S, Tanaka T, et al. Three-field dissection for squamous cell carcinoma in the thoracic esophagus. Ann Thorac Cardiovase Surg, 2002, 8(6):328-335.
9.	Berger AC, Bloomenthal A, Weksler B, et al. Oncologic efficacy is not compromised, and may be improved with minimally invasive esophagectomy. J Am Coll Surg, 2011, 212(4):560-566.
10.	王學中, 孟凡利. 胸段食管癌的淋巴結轉移規律及影響因素研究.山東大學碩士學位論文, 2007:15.
11.	Akiyama H, Tsurumaru M, Udagawa H, et al. Radical lymph node dissection for cancer of esophagus. Ann Surg, 1994, 220(3):364-373.
12.	Shiozaki H, Yano M, Tsujinaka T, et al. Lymph node metastasis along the recurrent nerve chain is an indication for cervical lymph node dissection in thoracic esophageal cancer. Dis Esophagus, 2001, 14(3-4): 191-196.
13.	律方, 薛奇, 邵康, 等. 國際抗癌聯盟-美國癌癥聯合委員會食管癌分期第7版臨床應用的初步體會. 中華腫瘤雜志, 2012, 34(6):461-464.
14.	柳碩巖, 鄭慶豐, 王楓, 等. 胸腔鏡腹腔鏡下食管癌三野淋巴結清掃術必要性與可行性. 中華胸心血管外科雜志, 2013, 29(7):394-397.
15.	于頻, 主編. 系統解剖學. 第4版. 北京:人民衛生出版社, 1996. 295-296.
16.	丁建勇, 徐松濤. 食管癌三野淋巴結清掃術的回顧和展望. 中國臨床醫學, 2011, 18(6):879-882.
17.	Dantoc MM, Cox MR, Esliek GD. Does minimally invasive esophagectomy(MIE) provide for comparable oncologic outcomes to open techniques?A systematic review. J Gastrointest Surg, 2012, 16(3):486-494.
18.	Fujita H, Sueyoshi S, Tanaka T, et al. Optimal lymphadenectomy for squamous cell carcinoma in the thoracic esophagus:comparing the short-and long-term outcome among the four types of lymphadenectomy. World J Surg, 2003, 27(5):571-579.
19.	冒志明, 劉勁柏, 趙凱國, 等. 經胸頸段食管胃機械吻合術的臨床應用(附82例報告). 中華胸心血管外科雜志, 1996, 12(2):89-90.
20.	褚雪峰, 冒志明. 經左胸頸段食管胃機械吻合術治216例食管癌.中國癌癥雜志, 2000, 10(3):247-249.
21.	于長海, 孫玉鶚. 經胸食管胃頸部機械吻合在食管癌手術中的應用. 中華胸心血管外科雜志, 2000, 16(2):114-115.
22.	王強, 高俊, 凡天友, 等. 改良Ivor-Lewis術式在食管癌手術中的應用體會.河南腫瘤學雜志, 2001, 14(6):414-415.
23.	袁風林, 張利萍, 孫冬蘭. 經胸食管胃頸部機械吻合在食管癌手術中的應用. 中國腫瘤臨床與康復, 2003, 10(3):274.
24.	張曉, 郎保平, 靳超, 等. 經胸食管胃頸部機械吻合在食管癌治療中的應用.河南科技大學學報(醫學版), 2004, 22(2):87-88.
25.	錢衛平, 徐林友, 吳斌. 經右胸食管胃頸部機械吻合32例分析. 皖南醫學院學報, 2010, 29(1):62-63.
26.	汪永和, 魏祥志, 岳慶峰, 等. 中段食管癌根治術擴大二野清掃淋巴結的臨床體會. 安徽醫學, 2013, 34(1):31-33.
27.	中國醫師協會食管外科專家委員會.微創食管癌切除術(minimally invasive esophagectomy, MIE)專家共識. 中華胸心血管外科雜志, 2013, 29(7):385-387.
28.	傅劍華. 食管癌微創切除術學習過程的幾個問題. 中華胸心血管外科雜志, 2013, 29(7):388-398.
29.	馬明全, 姜宏景, 唐鵬, 等. 胸腔鏡微創與開放食管癌根治術圍手術期并發癥和淋巴結清掃情況的回顧性比較. 中華胸心血管外科雜志, 2015, 31(5):260-263.
30.	柳碩巖, 黃書榮, 王楓, 等. 單腔、雙腔氣管插管在胸腔鏡聯合腹腔鏡下食管癌三野根治術中的應用. 中華胸心血管外科雜志, 2015, 31(5):64-266.
31.	李輝, 張曄.微創時代食管外科的現狀與思考. 中華消化外科雜志, 2013, 12(10):734-736.
32.	Godiris-Petit G, Munoz-Bongrand N, Honigman I, et al. Minimally invasive esophagectomy for cancer:prospective evaluation of laparo-scopic gastric mobilization. World J Surg, 2006, 30(8):1434-1440.
33.	Schr?der W, H?lscher AH, Bludau M, et al. Ivor-Lewis esophagec-tomy with and without laparoscopic conditioning of the gastric conduit. World J Surg, 2010, 34(4):738-743.
34.	Avital S, Zundel N, Szomstein S, et al. Laparoscopic transhiatal esop-hagectomy for esophageal cancer. Am J Surg, 2005, 190(1):69-74.
35.	B?ttger T, Terzic A, Müller M, et al. Minimally invasive transhiatal and transthoracic esophagectomy. Surg Endosc, 2007, 21(10):1695-1700.
36.	韋海濤, 李麗, 王作培, 等. 全腔鏡下選擇性頸胸腹三野淋巴結清掃與胸腹二野淋巴結清掃近期臨床療效的對比. 中華胸心血管外科雜志, 2015, 31(12):755-758.

1. 冒志明, 顧曉華, 李昌炎, 等. Ivor-Lewis經胸頸部機械吻合術治療中段食管癌的前瞻性研究. 中華消化外科雜志, 2013, 12(10):754-758.
2. 冒志明, 顧曉華, 李昌炎, 等. 頸胸交界部淋巴結轉移特征及清掃價值的前瞻性隊列研究.中國胸心血管外科臨床雜志, 2015, 22(11): 1031-1035.
3. Kuwano H, Nishimura Y, Oyama Y, et al. Guidelines for diagnosis and treatment of carcinoma of the esophagus April 2012 edited by the Japan Esophageal Society. Esophagu, 2015, 12(1):1-30.
4. 方文濤, 茅騰, 谷志濤. 微創食管癌根治術——優勢與風險. 中華胸心血管外科雜志, 2013, 29(7):392-393.
5. 毛友生, 赫捷, 薛奇, 等. 全國食管癌規范化診治推廣之路. 中華胃腸外科雜志, 2013, 16(9):801-804.
6. Herbella FA, Del Grande JC, Colleonim R, et al. Anatomical analysis of the mediastinal lymph nodes of normal Brazilian subjects according to the classification of the Japanese Society for Diseases of the Esophagus. J Surg today, 2003, 33(4):249-253.
7. Lerut T, Nafteux P, Moons J, et al. Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 R0 resection:impact on staging, disease-free survival and outcome: a plea for adaptation TNM classification in upper-half esophageal carcinoma. J Ann Surg, 2004, 240(6):962-974.
8. Fujita H, Sueyoshi S, Tanaka T, et al. Three-field dissection for squamous cell carcinoma in the thoracic esophagus. Ann Thorac Cardiovase Surg, 2002, 8(6):328-335.
9. Berger AC, Bloomenthal A, Weksler B, et al. Oncologic efficacy is not compromised, and may be improved with minimally invasive esophagectomy. J Am Coll Surg, 2011, 212(4):560-566.
10. 王學中, 孟凡利. 胸段食管癌的淋巴結轉移規律及影響因素研究.山東大學碩士學位論文, 2007:15.
11. Akiyama H, Tsurumaru M, Udagawa H, et al. Radical lymph node dissection for cancer of esophagus. Ann Surg, 1994, 220(3):364-373.
12. Shiozaki H, Yano M, Tsujinaka T, et al. Lymph node metastasis along the recurrent nerve chain is an indication for cervical lymph node dissection in thoracic esophageal cancer. Dis Esophagus, 2001, 14(3-4): 191-196.
13. 律方, 薛奇, 邵康, 等. 國際抗癌聯盟-美國癌癥聯合委員會食管癌分期第7版臨床應用的初步體會. 中華腫瘤雜志, 2012, 34(6):461-464.
14. 柳碩巖, 鄭慶豐, 王楓, 等. 胸腔鏡腹腔鏡下食管癌三野淋巴結清掃術必要性與可行性. 中華胸心血管外科雜志, 2013, 29(7):394-397.
15. 于頻, 主編. 系統解剖學. 第4版. 北京:人民衛生出版社, 1996. 295-296.
16. 丁建勇, 徐松濤. 食管癌三野淋巴結清掃術的回顧和展望. 中國臨床醫學, 2011, 18(6):879-882.
17. Dantoc MM, Cox MR, Esliek GD. Does minimally invasive esophagectomy(MIE) provide for comparable oncologic outcomes to open techniques?A systematic review. J Gastrointest Surg, 2012, 16(3):486-494.
18. Fujita H, Sueyoshi S, Tanaka T, et al. Optimal lymphadenectomy for squamous cell carcinoma in the thoracic esophagus:comparing the short-and long-term outcome among the four types of lymphadenectomy. World J Surg, 2003, 27(5):571-579.
19. 冒志明, 劉勁柏, 趙凱國, 等. 經胸頸段食管胃機械吻合術的臨床應用(附82例報告). 中華胸心血管外科雜志, 1996, 12(2):89-90.
20. 褚雪峰, 冒志明. 經左胸頸段食管胃機械吻合術治216例食管癌.中國癌癥雜志, 2000, 10(3):247-249.
21. 于長海, 孫玉鶚. 經胸食管胃頸部機械吻合在食管癌手術中的應用. 中華胸心血管外科雜志, 2000, 16(2):114-115.
22. 王強, 高俊, 凡天友, 等. 改良Ivor-Lewis術式在食管癌手術中的應用體會.河南腫瘤學雜志, 2001, 14(6):414-415.
23. 袁風林, 張利萍, 孫冬蘭. 經胸食管胃頸部機械吻合在食管癌手術中的應用. 中國腫瘤臨床與康復, 2003, 10(3):274.
24. 張曉, 郎保平, 靳超, 等. 經胸食管胃頸部機械吻合在食管癌治療中的應用.河南科技大學學報(醫學版), 2004, 22(2):87-88.
25. 錢衛平, 徐林友, 吳斌. 經右胸食管胃頸部機械吻合32例分析. 皖南醫學院學報, 2010, 29(1):62-63.
26. 汪永和, 魏祥志, 岳慶峰, 等. 中段食管癌根治術擴大二野清掃淋巴結的臨床體會. 安徽醫學, 2013, 34(1):31-33.
27. 中國醫師協會食管外科專家委員會.微創食管癌切除術(minimally invasive esophagectomy, MIE)專家共識. 中華胸心血管外科雜志, 2013, 29(7):385-387.
28. 傅劍華. 食管癌微創切除術學習過程的幾個問題. 中華胸心血管外科雜志, 2013, 29(7):388-398.
29. 馬明全, 姜宏景, 唐鵬, 等. 胸腔鏡微創與開放食管癌根治術圍手術期并發癥和淋巴結清掃情況的回顧性比較. 中華胸心血管外科雜志, 2015, 31(5):260-263.
30. 柳碩巖, 黃書榮, 王楓, 等. 單腔、雙腔氣管插管在胸腔鏡聯合腹腔鏡下食管癌三野根治術中的應用. 中華胸心血管外科雜志, 2015, 31(5):64-266.
31. 李輝, 張曄.微創時代食管外科的現狀與思考. 中華消化外科雜志, 2013, 12(10):734-736.
32. Godiris-Petit G, Munoz-Bongrand N, Honigman I, et al. Minimally invasive esophagectomy for cancer:prospective evaluation of laparo-scopic gastric mobilization. World J Surg, 2006, 30(8):1434-1440.
33. Schr?der W, H?lscher AH, Bludau M, et al. Ivor-Lewis esophagec-tomy with and without laparoscopic conditioning of the gastric conduit. World J Surg, 2010, 34(4):738-743.
34. Avital S, Zundel N, Szomstein S, et al. Laparoscopic transhiatal esop-hagectomy for esophageal cancer. Am J Surg, 2005, 190(1):69-74.
35. B?ttger T, Terzic A, Müller M, et al. Minimally invasive transhiatal and transthoracic esophagectomy. Surg Endosc, 2007, 21(10):1695-1700.
36. 韋海濤, 李麗, 王作培, 等. 全腔鏡下選擇性頸胸腹三野淋巴結清掃與胸腹二野淋巴結清掃近期臨床療效的對比. 中華胸心血管外科雜志, 2015, 31(12):755-758.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Improved Ivor-Lewis Cervical Stapled Esophagogastrostomy via Thorax for Middle Esophageal Carcinoma: An Ambispective Cohort Study

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