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

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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, 顾晓华, 李昌炎, 等. Ivor-Lewis经胸颈部机械吻合术治疗中段食管癌的前瞻性研究. 中华消化外科杂志, 2013, 12(10):754-758.
2.	冒志明, 顾晓华, 李昌炎, 等. 颈胸交界部淋巴结转移特征及清扫价值的前瞻性队列研究.中国胸心血管外科临床杂志, 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.	方文涛, 茅腾, 谷志涛. 微创食管癌根治术——优势与风险. 中华胸心血管外科杂志, 2013, 29(7):392-393.
5.	毛友生, 赫捷, 薛奇, 等. 全国食管癌规范化诊治推广之路. 中华胃肠外科杂志, 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.	王学中, 孟凡利. 胸段食管癌的淋巴结转移规律及影响因素研究.山东大学硕士学位论文, 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. 国际抗癌联盟-美国癌症联合委员会食管癌分期第7版临床应用的初步体会. 中华肿瘤杂志, 2012, 34(6):461-464.
14.	柳硕岩, 郑庆丰, 王枫, 等. 胸腔镜腹腔镜下食管癌三野淋巴结清扫术必要性与可行性. 中华胸心血管外科杂志, 2013, 29(7):394-397.
15.	于频, 主编. 系统解剖学. 第4版. 北京:人民卫生出版社, 1996. 295-296.
16.	丁建勇, 徐松涛. 食管癌三野淋巴结清扫术的回顾和展望. 中国临床医学, 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, 刘劲柏, 赵凯国, 等. 经胸颈段食管胃机械吻合术的临床应用(附82例报告). 中华胸心血管外科杂志, 1996, 12(2):89-90.
20.	褚雪峰, 冒志明. 经左胸颈段食管胃机械吻合术治216例食管癌.中国癌症杂志, 2000, 10(3):247-249.
21.	于长海, 孙玉鹗. 经胸食管胃颈部机械吻合在食管癌手术中的应用. 中华胸心血管外科杂志, 2000, 16(2):114-115.
22.	王强, 高俊, 凡天友, 等. 改良Ivor-Lewis术式在食管癌手术中的应用体会.河南肿瘤学杂志, 2001, 14(6):414-415.
23.	袁风林, 张利萍, 孙冬兰. 经胸食管胃颈部机械吻合在食管癌手术中的应用. 中国肿瘤临床与康复, 2003, 10(3):274.
24.	张晓, 郎保平, 靳超, 等. 经胸食管胃颈部机械吻合在食管癌治疗中的应用.河南科技大学学报(医学版), 2004, 22(2):87-88.
25.	钱卫平, 徐林友, 吴斌. 经右胸食管胃颈部机械吻合32例分析. 皖南医学院学报, 2010, 29(1):62-63.
26.	汪永和, 魏祥志, 岳庆峰, 等. 中段食管癌根治术扩大二野清扫淋巴结的临床体会. 安徽医学, 2013, 34(1):31-33.
27.	中国医师协会食管外科专家委员会.微创食管癌切除术(minimally invasive esophagectomy, MIE)专家共识. 中华胸心血管外科杂志, 2013, 29(7):385-387.
28.	傅剑华. 食管癌微创切除术学习过程的几个问题. 中华胸心血管外科杂志, 2013, 29(7):388-398.
29.	马明全, 姜宏景, 唐鹏, 等. 胸腔镜微创与开放食管癌根治术围手术期并发症和淋巴结清扫情况的回顾性比较. 中华胸心血管外科杂志, 2015, 31(5):260-263.
30.	柳硕岩, 黄书荣, 王枫, 等. 单腔、双腔气管插管在胸腔镜联合腹腔镜下食管癌三野根治术中的应用. 中华胸心血管外科杂志, 2015, 31(5):64-266.
31.	李辉, 张晔.微创时代食管外科的现状与思考. 中华消化外科杂志, 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.	Schröder W, Hölscher 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.	Böttger T, Terzic A, Müller M, et al. Minimally invasive transhiatal and transthoracic esophagectomy. Surg Endosc, 2007, 21(10):1695-1700.
36.	韦海涛, 李丽, 王作培, 等. 全腔镜下选择性颈胸腹三野淋巴结清扫与胸腹二野淋巴结清扫近期临床疗效的对比. 中华胸心血管外科杂志, 2015, 31(12):755-758.

1. 冒志明, 顾晓华, 李昌炎, 等. Ivor-Lewis经胸颈部机械吻合术治疗中段食管癌的前瞻性研究. 中华消化外科杂志, 2013, 12(10):754-758.
2. 冒志明, 顾晓华, 李昌炎, 等. 颈胸交界部淋巴结转移特征及清扫价值的前瞻性队列研究.中国胸心血管外科临床杂志, 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. 方文涛, 茅腾, 谷志涛. 微创食管癌根治术——优势与风险. 中华胸心血管外科杂志, 2013, 29(7):392-393.
5. 毛友生, 赫捷, 薛奇, 等. 全国食管癌规范化诊治推广之路. 中华胃肠外科杂志, 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. 王学中, 孟凡利. 胸段食管癌的淋巴结转移规律及影响因素研究.山东大学硕士学位论文, 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. 国际抗癌联盟-美国癌症联合委员会食管癌分期第7版临床应用的初步体会. 中华肿瘤杂志, 2012, 34(6):461-464.
14. 柳硕岩, 郑庆丰, 王枫, 等. 胸腔镜腹腔镜下食管癌三野淋巴结清扫术必要性与可行性. 中华胸心血管外科杂志, 2013, 29(7):394-397.
15. 于频, 主编. 系统解剖学. 第4版. 北京:人民卫生出版社, 1996. 295-296.
16. 丁建勇, 徐松涛. 食管癌三野淋巴结清扫术的回顾和展望. 中国临床医学, 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, 刘劲柏, 赵凯国, 等. 经胸颈段食管胃机械吻合术的临床应用(附82例报告). 中华胸心血管外科杂志, 1996, 12(2):89-90.
20. 褚雪峰, 冒志明. 经左胸颈段食管胃机械吻合术治216例食管癌.中国癌症杂志, 2000, 10(3):247-249.
21. 于长海, 孙玉鹗. 经胸食管胃颈部机械吻合在食管癌手术中的应用. 中华胸心血管外科杂志, 2000, 16(2):114-115.
22. 王强, 高俊, 凡天友, 等. 改良Ivor-Lewis术式在食管癌手术中的应用体会.河南肿瘤学杂志, 2001, 14(6):414-415.
23. 袁风林, 张利萍, 孙冬兰. 经胸食管胃颈部机械吻合在食管癌手术中的应用. 中国肿瘤临床与康复, 2003, 10(3):274.
24. 张晓, 郎保平, 靳超, 等. 经胸食管胃颈部机械吻合在食管癌治疗中的应用.河南科技大学学报(医学版), 2004, 22(2):87-88.
25. 钱卫平, 徐林友, 吴斌. 经右胸食管胃颈部机械吻合32例分析. 皖南医学院学报, 2010, 29(1):62-63.
26. 汪永和, 魏祥志, 岳庆峰, 等. 中段食管癌根治术扩大二野清扫淋巴结的临床体会. 安徽医学, 2013, 34(1):31-33.
27. 中国医师协会食管外科专家委员会.微创食管癌切除术(minimally invasive esophagectomy, MIE)专家共识. 中华胸心血管外科杂志, 2013, 29(7):385-387.
28. 傅剑华. 食管癌微创切除术学习过程的几个问题. 中华胸心血管外科杂志, 2013, 29(7):388-398.
29. 马明全, 姜宏景, 唐鹏, 等. 胸腔镜微创与开放食管癌根治术围手术期并发症和淋巴结清扫情况的回顾性比较. 中华胸心血管外科杂志, 2015, 31(5):260-263.
30. 柳硕岩, 黄书荣, 王枫, 等. 单腔、双腔气管插管在胸腔镜联合腹腔镜下食管癌三野根治术中的应用. 中华胸心血管外科杂志, 2015, 31(5):64-266.
31. 李辉, 张晔.微创时代食管外科的现状与思考. 中华消化外科杂志, 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. Schröder W, Hölscher 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. Böttger T, Terzic A, Müller M, et al. Minimally invasive transhiatal and transthoracic esophagectomy. Surg Endosc, 2007, 21(10):1695-1700.
36. 韦海涛, 李丽, 王作培, 等. 全腔镜下选择性颈胸腹三野淋巴结清扫与胸腹二野淋巴结清扫近期临床疗效的对比. 中华胸心血管外科杂志, 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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