PDF(Pubmed)
Abstract：
BACKGROUND: Minimally invasive transcervical oesophagectomy is a surgical technique that offers radical oesophagectomy without the need for transthoracic access. The aim of this study was to evaluate the safety and feasibility of the minimally invasive transcervical oesophagectomy procedure and to report the refinement of this technique in a Western cohort.
METHODS: A single-centre prospective cohort study was designed as an IDEAL stage 2A study. Patients with oesophageal cancer (cT1b-4a N0-3 M0) who were scheduled for oesophagectomy with curative intent were eligible for inclusion in the study. The main outcome parameter was the postoperative pulmonary complication rate and the secondary outcomes were the anastomotic leakage, recurrent laryngeal nerve palsy, and R0 resection rates, as well as the lymph node yield.
RESULTS: In total, 75 patients underwent minimally invasive transcervical oesophagectomy between January 2021 and November 2023. Several modifications to the surgical technique were registered, evaluated, and implemented in the context of IDEAL stage 2A. A total of 12 patients (16%) had postoperative pulmonary complications, including pneumonia (4 patients) and pleural effusion with drainage or aspiration (8 patients). Recurrent laryngeal nerve palsy was observed in 33 of 75 patients (44%), with recovery in 30 of 33 patients (91%). A total of 5 of 75 patients (7%) had anastomotic leakage. The median number of resected lymph nodes was 29 (interquartile range 22-37) and the R0 resection rate was 96% (72 patients).
CONCLUSIONS: Introducing minimally invasive transcervical oesophagectomy for oesophageal cancer in a Dutch institution is associated with a low rate of postoperative pulmonary complications and a high rate of temporary recurrent laryngeal nerve palsy.
METHODS: A single-centre prospective cohort study was designed as an IDEAL stage 2A study. Patients with oesophageal cancer (cT1b-4a N0-3 M0) who were scheduled for oesophagectomy with curative intent were eligible for inclusion in the study. The main outcome parameter was the postoperative pulmonary complication rate and the secondary outcomes were the anastomotic leakage, recurrent laryngeal nerve palsy, and R0 resection rates, as well as the lymph node yield.
RESULTS: In total, 75 patients underwent minimally invasive transcervical oesophagectomy between January 2021 and November 2023. Several modifications to the surgical technique were registered, evaluated, and implemented in the context of IDEAL stage 2A. A total of 12 patients (16%) had postoperative pulmonary complications, including pneumonia (4 patients) and pleural effusion with drainage or aspiration (8 patients). Recurrent laryngeal nerve palsy was observed in 33 of 75 patients (44%), with recovery in 30 of 33 patients (91%). A total of 5 of 75 patients (7%) had anastomotic leakage. The median number of resected lymph nodes was 29 (interquartile range 22-37) and the R0 resection rate was 96% (72 patients).
CONCLUSIONS: Introducing minimally invasive transcervical oesophagectomy for oesophageal cancer in a Dutch institution is associated with a low rate of postoperative pulmonary complications and a high rate of temporary recurrent laryngeal nerve palsy.
摘要：
背景：微创经颈食管切除术是一种无需经胸途径即可提供根治性食管切除术的外科技术。这项研究的目的是评估微创经颈食管切除术的安全性和可行性，并在西方队列中报告该技术的改进。
方法：单中心前瞻性队列研究设计为IDEAL2A期研究。食管癌患者（cT1b-4aN0-3M0）计划进行食管切除术并有治愈意向，符合纳入研究的条件。主要结局参数是术后肺部并发症发生率，次要结局是吻合口漏，喉返神经麻痹,和R0切除率，以及淋巴结产量。
结果：总计，在2021年1月至2023年11月期间，75例患者接受了微创经颈食管切除术。对手术技术进行了一些修改，评估，并在理想阶段2A的背景下实施。共有12例患者(16%)发生术后肺部并发症,包括肺炎（4例）和胸腔积液伴引流或抽吸（8例）。75例患者中有33例(44%)出现喉返神经麻痹,33例患者中有30例（91%）康复。75例患者中共有5例（7％）发生吻合口漏。切除淋巴结的中位数为29个（四分位距22-37个），R0切除率为96％（72例）。
结论：在一家荷兰机构中引入微创经颈食管切除术治疗食管癌与术后肺部并发症发生率低和暂时性喉返神经麻痹发生率高相关。
方法：单中心前瞻性队列研究设计为IDEAL2A期研究。食管癌患者（cT1b-4aN0-3M0）计划进行食管切除术并有治愈意向，符合纳入研究的条件。主要结局参数是术后肺部并发症发生率，次要结局是吻合口漏，喉返神经麻痹,和R0切除率，以及淋巴结产量。
结果：总计，在2021年1月至2023年11月期间，75例患者接受了微创经颈食管切除术。对手术技术进行了一些修改，评估，并在理想阶段2A的背景下实施。共有12例患者(16%)发生术后肺部并发症,包括肺炎（4例）和胸腔积液伴引流或抽吸（8例）。75例患者中有33例(44%)出现喉返神经麻痹,33例患者中有30例（91%）康复。75例患者中共有5例（7％）发生吻合口漏。切除淋巴结的中位数为29个（四分位距22-37个），R0切除率为96％（72例）。
结论：在一家荷兰机构中引入微创经颈食管切除术治疗食管癌与术后肺部并发症发生率低和暂时性喉返神经麻痹发生率高相关。
