微创McKeown食管切除术治疗食管下段癌的临床价值

目的探讨微创McKeown食管切除术治疗下段食管癌的临床价值。方法选取2013-01-2017-06间在郑州大学第一附属医院接受食管切除术的下段食管癌患者。将行微创McKeown手术的患者作为微创组,将行开放Sweet手术的患者作为开放组,倾向得分匹配(PSM)用于降低2组一般资料的统计学差异。比较2组患者的疗效。结果全部患者均顺利完成手术。2组患者的病死率、肺部并发症和吻合口漏发生率差异无统计学意义(P>0.05)。微创组淋巴结清扫数、平均住院费用和手术时间均多于开放组,差异均有统计学意义(P<0.05)。结论微创McKeown食管切除术治疗下段食管癌,较传统开放手术淋巴结清扫数多,但手术时间和治疗费用较多。     

腹腔镜胆囊切除术中意外胆囊癌的临床诊治体会

目的:总结腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中意外胆囊癌(unexpected gallbladder carcinoma,UGC)的临床病理特点,探讨手术方法及预防转移复发的对策。方法:回顾分析1997年8月至2008年11月5 586例LC术中26例(0.47%)UGC患者的临床资料,应用Kaplan-Meier法对比单纯胆囊切除术组、胆囊癌根治术组及pTis、pT1期与pT2、pT3、pT4期患者的累积生存率。结果:26例UGC患者中,术前诊断以胆囊结石和胆囊息肉为主。按病理分期,pTis期2例,pT1a期4例,pT1b期3例,pT2期10例,pT3期5例,pT4期2例。胆囊癌根治组患者累积生存率优于单纯胆囊切除组;pTis、pT1期患者预后显著优于pT2、pT3、pT4期。结论:具有胆囊癌高危因素的患者,术前应全面分析临床资料,术中仔细剖检胆囊,标本行冰冻切片检查,一旦确诊应早期行根治性切除术,术中需采取措施预防肿瘤种植和转移。     

局部进展期食管癌新辅助治疗后微创手术可行性分析的病例对照研究

目的探讨局部进展期食管癌新辅助治疗后行微创手术的安全性和有效性。方法回顾性分析上海交通大学附属胸科医院胸外科2015~2016年连续收治的新辅助治疗后行手术治疗局部进展期食管癌患者56例的临床资料,男51例、女5例。将患者分为开放手术组[OE组,25例,年龄61(50~73)岁]和微创手术组[MIE组,31例,60(55~79)岁]两组。结果行新辅助同步放化疗28例,新辅助化疗28例。新辅助同步放化疗患者的病理完全缓解(p CR)率明显高于新辅助化疗患者(21.4%vs.10.7%,P0.05)。MIE组手术时间、术中失血量、R2切除率及淋巴结清扫数量比OE组有明显优势,差异有统计学意义(P0.05)。两组双侧喉返神经旁淋巴结清扫数量和淋巴结转移比例差异无统计学意义(P0.05)。MIE组术后呼吸系统并发症发生率低于OE组,差异有统计学意义(P=0.041)。两组患者其它并发症、二次手术、再入ICU、术后住院时间及术后30 d死亡率差异均无统计学意义(P0.05)。新辅助放化疗联合OE组1例患者因术后食管气管瘘胃液窒息而死亡。结论新辅助治疗联合MIE治疗局部进展期食管癌安全可行且能够达到与OE相当的肿瘤学根治效果。     

围手术期输血对食管鳞癌患者生存影响的随机分组研究

目的就围手术期输血对食管鳞癌患者(ESCC)生存的影响进行前瞻性随机分组研究.方法 1997年8月～1998年1月,311例ESCC接受手术治疗者随机分为围手术期不输血组(A)和输血组(B),符合研究条件者计286例,其中A组148例,B组138例,B组输血量平均为800ml.比较两组临床病理学指标与预后关系及输血对生存的影响.结果两组间手术时间、术中失血量、病理分期差异均无显著性(P＞0.05).至2000年1月最后1次随访时,围手术期A组与B组分别存活82例、73例,中位生存时间分别为27.48个月和29.59个月.两组6、12、18、24个月存活率差异无显著性(P>0.050).平均生存时间A组好于B组,分别为21.74±7.38,19.54±8.76(t′=2.287,P=0.023).多因素分析显示影响生存的因素依次为手术性质、TNM分期及围手术期输血.输血是影响生存的独立因素.TNM分层发现Ⅰ+Ⅱa期输血与否的生存时间差异无显著性(P＞0.05),而Ⅱb+Ⅲ期输血与否差异有显著性(t′= 2.570,P=0.011).结论 ESCC输血与术后生存负相关.为改善预后手术医生应在术中精细操作,减少失血,致力于避免或减少不必要输血的研究.     

两种不同消化道重建方式在近端胃癌切除术中的应用

本研究对根治性近端胃大部切除术后患者使用食管残胃间空肠间置术进行消化道重建,并与近端胃癌全胃切除Roux-en-Y吻合术进行比较,观察两组患者手术时间、手术并发症、术后生活质量及营养状况的变化. 资料与方法 1.一般资料:选择河南省肿瘤医院普外科2010年10月至2012年4月行根治性近侧胃大部切除食管残胃间空肠间置(观察组)32例、全胃切除食管空肠Roux-en-Y吻合(对照组)30例的胃癌患者,其中男46例,女16例;年龄(58±10)岁.术后病理检查结果:观察组:Ⅰa期5例,Ⅰb期9例,Ⅱ期12例,Ⅲa期6例;对照组:Ⅰb期3例,Ⅱ期5例,Ⅲa期10例,Ⅲb期12例.     

浸润深度对接受左侧开胸手术的pT1期胸中段食管癌患者预后的影响北大核心CSCD

目的探讨浸润深度对接受左侧开胸手术的pT1期胸中段食管癌患者预后的影响。方法回顾性分析139例符合入组条件的食管胸中段癌术后pT1N0M0期患者的临床病历资料。首先分析全组患者的预后及其影响因素,并比较pT1a期和pT1b期患者预后、局部区域复发和远处转移的差异,同时分析不同浸润深度对患者预后及治疗失败的影响。应用SPSS 25.0软件进行统计学分析。结果全组患者1、3、5年总生存率(OS)和无病生存率(DFS)分别为95.0%、87.8%、82.0%和91.4%、84.2%、77.0%。pT1a和pT1b期患者1、3、5年OS(χ^(2)=7.500,P=0.006)和DFS(χ^(2)=7.354,P=0.007)差异均有统计学意义。Cox多因素分析结果显示pT分期和病理类型为患者OS和DFS的独立性预后影响因素(P<0.05)。pT1a期肿瘤各不同浸润深度的OS(χ^(2)=0.734,P=0.693)和DFS(χ^(2)=0.7690,P=0.681)差异均无统计学意义;pT1b期肿瘤各不同浸润深度的1、3、5年OS(χ^(2)=15.368,P<0.001)和DFS(χ^(2)=27.470,P<0.001)差异均有统计学意义。pT1b期的复发率(23.8%)显著高于pT1a期(5.3%)患者(χ^(2)=5.274,P=0.022);前者的远处转移率(10.9%)亦显著性高于后者(0)(χ^(2)=4.494,P=0.034)。pT1b期患者不同浸润深度之间的局部区域复发率(χ^(2)=17.051,P<0.001)和远处转移率(χ^(2)=15.460,P<0.001)差异均有统计学意义。影响pT1b期患者治疗后失败的logistic多因素分析结果显示浸润深度为影响其出现局部区域复发的独立性因素(P<0.001);病理类型(P=0.003)和浸润深度(P=0.027)为影响其出现远处转移的独立性因素。结论pT1a期和pT1b期患者的预后及治疗后失败模式不尽相同,且pT1b期患者的不同浸润深度与患者的预后及其治疗后失败模式显著相关,浸润深度为影响pT1b期患者治疗后失败的独立性影响因素,建议临床医师应该重视pT1b期患者的术后辅助治疗。此结论需要大宗病例前瞻性研究结果证实。     

微创食管癌切除术治疗食管鳞状细胞癌的临床效果

目的探究食管鳞状细胞癌实施微创食管癌切除术治疗对并发症及治疗效果的影响。方法纳入研究对象均按照入院时间分组,对照组30例患者于2010年12月至2014年6月入院,实验组30例患者于2014年7月至2019年12月入院,实验组实施微创食管癌切除术、对照组实施开放食管癌切除术,对比分析两组患者手术情况、疗效及安全性。结果实验组治疗总有效率为96.67%显著高于对照组80.00%,具统计学差异(P0.05)。实验组手术时间比对照组长、术中出血量比对照组少、淋巴结清扫数目比对照组多,差异均具统计学意义(P0.05)。两组患者并发症率无较大差异(P0.05)。结论食管鳞状细胞癌采用经微创食管癌切除术治疗可提升临床治愈率、改善疾病症状,使病情进展得到有效控制,值得广泛应用及推广。     

经裂孔食管切除术在食管癌外科治疗中的评价

目的评价经裂孔食管切除术在食管癌外科治疗中的作用。方法总结分析2000年5月至2007年7月单一外科医生组对46例食管癌患者实施经裂孔食管切除术的病例资料。结果本组患者食管鳞癌44例，食管腺癌1例，食管类癌1例。位于颈段者11例，胸上段者21例．胸中段者5例，胸下段者9例。行术前化疗者6例。按国际TNM分期：0期者3例；Ⅰ期者6例：Ⅱa期者17例；Ⅱb期者2例；Ⅲ期者16例；2例为化疗后病理完全缓解。胃代食管者42例，结肠代食管者4例。术前肺功能FEV1低于0．8L或FEV1／FVC低于50％者29例。46例均获切除,切缘阴性，无手术死亡。术后声音嘶哑2例，心律失常3例，双侧胸腔积液1例，6例出现小的颈部吻合口瘘。结论经裂孔食管切除术在食管癌的外科治疗中对高龄、心肺功能差而不能耐受剖胸手术患者是理想的选择。     

微创食管切除术治疗食管癌的研究进展

食管癌是全世界8大常见恶性肿瘤之一,外科手术仍为最主要的治疗方案。传统开放食管切除术术后并发症发生率高,患者生活质量较差。为减少手术并发症、提高患者的生活质量,微创食管切除术逐渐被胸外科医师接受并应用于食管癌的治疗当中。目前,多数研究认为微创食管切除术是安全、可行的,同时术后并发症发生率等短期效果优于开放食管切除术,而总生存率等远期效果并不低于开放食管切除术。随着研究的不断细化深入,食管癌的精准微创治疗将得到进一步的发展和推广。     

直肠癌经肛内窥镜微创手术后局部复发的治疗及其结果

经肛内窥镜微创手术是更快和更安全的替代传统手术治疗腺瘤和低危险（T1期）直肠癌的方法,但其有较高的复发率。为探讨经肛内窥镜微创手术后局部复发患者的治疗并评估其远期效果,Stipa等人进行了一项病例资料的回顾性研究。该研究纳入了1990～2011年期间罗马大型三级保健医院298例经肛内窥镜微创手术行肿瘤局部切除术（全层切除）的直肠腺癌患者,分析患者的特征、手术资料、病理诊断和肿瘤复发情况,应用Kaplan-Meyer法分析生存率,log-rank检验比较组间差异。结果显示：肿瘤分期为pT1期86例（59.7%）,pT2期38例（26.4%）,pT3期20例（13.9%）;     

胸腔镜腹腔镜联合手术与开放手术治疗食管癌的同期临床对照研究

目的 探讨和评价胸腔镜腹腔镜联合手术治疗食管癌的可行性、安全性、根治性以及近期临床疗效.方法 回顾性分析2007年7月至2009年10月收治的行电视胸腔镜、腹腔镜联合食管癌根治术(即微创组67例)和常规三切口开放食管癌根治术(即开放组38例)食管癌患者临床资料.比较两组手术指标、肿瘤学指标以及近期临床疗效.结果 两组患者性别组成、年龄结构、肺功能等差异无统计学意义,临床资料具有可比性.两组总手术时间以及胸、腹部手术时间差异无统计学意义,但微创组胸部及腹部术中出血量少于开放组(胸部112.3 ml比175.3 ml,P=0.035;腹部31.4 ml比100.5 ml,P=0.026),组间差异有统计学意义.术后转入ICU例数(P=0.042)和术后第3天疼痛情况(P=0.005)组间差异均有统计学意义.术后微创组呼吸系统并发症发生率低(10.4%比26.3%,P=0.046),开放组出现不完全性肠梗阻概率较大(0比8.6%,P=0.045),差异有统计学意义.微创组平均清扫淋巴结20.9枚,转移率为26.9%,开放组平均清扫淋巴结20.1枚,转移率为47.4%,组间淋巴结清扫数量差异无统计学意义.术后平均随访(14.0±2.2)个月,微创组和开放组患者总复发率分别为7.7%和10.8%,生存率分别为89.2%和86.5%,差异均无统计学意义.结论 电视胸腔镜腹腔镜联合食管癌手术具有明显微创优势,安全可行,近期疗效可靠,符合肿瘤外科根治原则.     

Thoracic Duct Resection During Esophagectomy Does Not Contribute to Improved Prognosis in Esophageal Squamous Cell Carcinoma: A Propensity Score Matched-Cohort Study

Purpose

Esophagectomy with extended lymphadenectomy remains the mainstay of treatment for localized esophageal squamous cell carcinoma (ESCC). Thoracic duct (TD) resection has been recommended as part of extended lymphadenectomy, although its merits are unclear. The aim of this two-institutional, matched-cohort study is to clarify whether TD resection improves prognosis in esophagectomy for ESCC.

Patients and Methods

In this two-institutional, matched-cohort study of 399 patients with ESCC who underwent McKeown esophagectomy between 2010 and 2014, the primary outcomes were overall survival (OS), disease-free survival (DFS), and cause-specific survival (CSS). Secondary outcomes were perioperative results and recurrence patterns.

Results

Based on a propensity score, 122 TD-resected or 122 TD-preserved patients in all stages were selected (median follow-up 4.5 years). The 5-year OS, DFS, and CSS rates in the TD-resected versus TD-preserved groups were 49% versus 60%, 53% versus 57%, and 58% versus 70%, respectively, without any significant differences. Operative time for the thoracic procedure was significantly longer and the number of retrieved mediastinal nodes was significantly higher in the TD-resected group (P = 0.009 and 0.005, respectively). The rates of chylothorax and left recurrent laryngeal nerve (RLN) palsy were significantly higher in the TD-resected group (P = 0.041 and 0.018, respectively). There were no significant differences in rates of local or distant metastases between the two groups.

Conclusions

TD resection does not contribute to improve OS, DFS, or CSS in ESCC but increases incidence of chylothorax and left RLN palsy. Prophylactic TD resection should be avoided in esophagectomy for ESCC.

     

胸腔镜与开放食管癌根治术中纵隔淋巴结清扫情况的比较

目的：比较胸腔镜食管癌根治术与开放手术的纵隔淋巴结清扫情况,探讨胸腔镜手术的根治性及安全性。方法回顾性分析2009年6月至2011年6月间四川省肿瘤医院胸外科经左颈右胸上腹食管癌根治术治疗304例患者的临床资料。其中199例行传统开放三切口食管癌根治术（开放组）,105例行胸腹腔镜三切口食管癌根治术（腔镜组）,比较两组患者术中淋巴结清扫情况及围手术期并发症发生情况。结果腔镜组清扫纵隔淋巴结数目为（10．1±5．5）枚,明显少于开放组的（13．3±7．5）枚（P＜0．01）;但匹配术后病理分期后,各期腔镜组和开放组的胸内淋巴结清扫数目差异并无统计学意义（均P＞0．05）。开放组和腔镜组左喉返神经旁淋巴结平均清扫数分别为（2．7±0．2）枚和（1．4±0．2）枚,下段食管旁分别为（1．0±0．1）枚和（0．6±0．1）枚,病灶旁分别为（1．7±0．2）枚和（0．7±0．1）枚,差异均有统计学意义（均P＜0．01）;其他区域两组淋巴结清扫数目差异均无统计学意义（均P＞0．05）。腔镜组围手术期并发症发生率为28．6％（30/105）,低于开放组的41．2％（82/199）（P＜0．05）,但喉返神经麻痹发生率[12．4％（13/105）]明显高于开放组[2．5％（5/199）,P＜0．01）。结论胸腔镜食管癌根治术安全可行。但在行胸腔镜纵隔淋巴结清扫时,应加强对喉返神经旁、下段食管旁和病灶旁淋巴结的清扫,并注意喉返神经的保护。     

肝内胆管癌根治性切除术中淋巴结清扫价值研究

目的 通过分析海军军医大学东方肝胆外科医院7年间诊断肝内胆管癌（ICC）并接受手术治疗病人的治疗及预后情况,探讨术中淋巴结清扫的意义。方法 回顾性分析2010年1月至2017年12月于海军军医大学东方肝胆外科医院经手术治疗的265例ICC病人资料。结果 共纳入265例病人,男性175例,女性90例。年龄22~86岁,中位年龄56.5岁。中位随访时间33.5个月。全部病人1、2、3年无瘤存活率分别为50%、29%、20%,中位无瘤生存时间11.9个月;1、2、3年总存活率分别为 77%、47%、36%,总中位生存时间22.8个月。COX多因素分析结果显示病人无瘤生存的影响因素包括糖尿病史、术前CA19-9高水平、肿瘤直径≥5 cm、肿瘤周边子灶、淋巴结是否清扫;病人总体生存的影响因素包括术前CA19-9高水平、肿瘤直径≥5 cm、血管侵犯、淋巴结是否清扫。分组对比经倾向评分匹配（PSM）后,淋巴结清扫组及未清扫组各77例。1、2、3年无瘤存活率:清扫组68%、47%、36% vs.未清扫组31%、13%、6%（P＜0.05）,中位无瘤生存时间：清扫组22.2个月 vs.未清扫组9.2个月。1、2、3年总存活率：清扫组91%、75%、56% vs.未清扫组71%、30%、21%（P＜0.05）,中位总生存时间：清扫组46.8个月vs.未清扫组17.0个月。剔除清扫组淋巴结阳性病人,比较清扫组中淋巴结病理学诊断阴性与未清扫病人生存情况,PSM后：清扫淋巴结阴性组及未清扫组各50例。1、2、3年无瘤存活率：清扫淋巴结阴性组77%、60%、52% vs.未清扫组32%、22%、15%（P＜0.05）,中位无瘤生存时间：清扫淋巴结阴性组38.1个月vs.未清扫组9.0个月。1、2、3年总存活率：清扫淋巴结阴性组94%、82%、74% vs.未清扫组68%、40%、28%,（P＜0.05）,中位总生存时间：清扫淋巴结阴性组54.0个月vs.未清扫组18.9个月。病人发生淋巴结转移的影响因素分析显示,肿瘤直径≥5 cm、术前CA19-9高水平是影响病人淋巴结转移的独立危险因素。结论 术中淋巴结清扫可改善ICC病人预后。术前无法明确淋巴结转移,但评估肿瘤可行根治性切除的ICC病人,伴随术前CA19-9水平较高、肿瘤直径较大时,术中应积极常规进行淋巴结清扫。     

保留乳头乳晕复合体的乳腺癌改良根治术预后的相关因素分析

目的探究影响保留乳头乳晕复合体(NAC)的乳腺癌改良根治术(NSM)预后的相关因素。 方法回顾性分析2011年1月至2014年12月84例早期原发性乳腺癌并接受NAC的NSM患者临床病理资料。使用统计软件SPSS 20.0进行数据分析,采用K-M生存曲线评估术后无病生存(DFS)及总生存(OS),采用单因素分析和Cox多因素分析影响NSM术后患者DFS和OPS的影响因素。P<0.05差异有统计学意义。 结果术后局部复发8例,远处转移6例,术后5年DFS为83.3%,OS为91.7%。多因素分析显示,肿瘤最大径、肿瘤距乳头乳晕距离(TND)、腋窝淋巴结状态、组织学类型及Her-2阳性是影响DFS的独立危险因素(P<0.05);而腋窝淋巴结状态是影响术后OS的独立危险因素(P<0.05)。 结论肿瘤最大径、TND、腋窝淋巴结状态、组织学类型及Her-2阳性是DFS的独立危险因素,腋窝淋巴结状态是OS的独立危险因素;腋窝淋巴结情况同时影响患者术后DFS和OS,术前系统、精准地评估并妥善处理特殊腋窝淋巴结可提高乳腺癌患者预后。     

Survival and quality of life after minimally invasive esophagectomy: a single-surgeon experience

Background

Reports on quality of life (QOL) after minimally invasive esophagectomy (MIE) have been limited. This report compares perioperative outcomes, survival, and QOL after MIEs with open transthoracic esophagectomy (TTE) and open transhiatal esophagectomy (THE).

Methods

After institutional review board approval, retrospective review of a prospectively maintained database identified patients who underwent esophageal resection for esophageal cancer at Creighton University between August 2003 and August 2010. Patients with preoperative stage 4 disease, emergent procedures, laparoscopic transhiatal esophagectomies, or esophagojeujunostomies were excluded from the study. The study patients were categorized as having undergone open TTE, open THE, or MIE. Overall survival (OS) was the interval between diagnosis and death or follow-up assessment. Disease-free survival (DFS) was the interval between surgery and recurrence, death, or follow-up assessment. For the patients who survived at least 1?year after surgery, QOL was assessed using European Organization for Research and Treatment of Cancer (EORTC-QLQ, version 3.0) and esophageal module (EORTC-QLQ OES 18) questionnaires.

Results

The study criteria were satisfied by 104 patients. Lymph node harvest with MIE (median = 20) was similar to that with open TTEs (median = 19) and significantly higher (P?P?Conclusions MIEs offer a safe and viable alternative to open esophagectomies because they reduce the need and volume of intraoperative blood product transfusion and postoperative respiratory complications without compromising oncological clearance, survival, and QOL.     

Open Versus Thoracoscopic Esophagectomy in Patients with Esophageal Squamous Cell Carcinoma

Background

The impact of minimally invasive esophagectomy on patient prognosis, particularly disease-free survival (DFS), has not been well addressed. We compared the clinical outcomes of open and thoracoscopic esophagectomy in patients with esophageal squamous cell carcinoma (ESCC).

Methods

Sixty-three and 66 patients, nonrandomized, underwent open and thoracoscopic esophagectomies for ESCC between 2008 and 2011 were included. The clinicopathological data were reviewed retrospectively. Perioperative outcome, overall survival (OS), DFS, and the recurrence sites after open and thoracoscopic esophagectomy were compared.

Results

The open and thoracoscopic groups were comparable with regard to the total number of harvested lymph nodes and the percentage patients undergoing R0 resection. Fewer patients in the thoracoscopic group had pneumonia and wound complications. Intensive care unit (ICU) stay also was shorter in the thoracoscopic group. The recurrence pattern was similar in the two groups. In the open and thoracoscopic groups, the 3-year OS rates were 47.6 and 70.9 % (p = 0.031), respectively, and the 3-year DFS rates were 35 and 62.4 % (p = 0.007), respectively. However, the trends in better OS and DFS in the thoracoscopic group were not significant after stratification according to pathologic stage.

Conclusions

The perioperative benefit of thoracoscopic esophagectomy included fewer postoperative complications and shorter ICU stays. Mid-term OS and DFS associated with thoracoscopic techniques are at least equivalent to those associated with open procedures.     

Minimally invasive esophagectomy for esophageal cancer: an updated review

Purpose

The surgical, postoperative and oncologic outcomes of minimally invasive esophagectomy (MIE) for esophageal cancer were reviewed to clarify the benefits of this surgical modality.

Methods

A systematic literature search was performed using synonyms for minimally invasive or thoracoscopic esophagectomy. There were 18 retrospective cohort studies and 3 meta-analyses retrieved in this review.

Results

There are several minimally invasive approaches for esophageal cancer. Total MIE using both the thoracoscopic and laparoscopic approach is increasingly performed. A longer operative time and less blood loss are observed with MIE in comparison to open esophagectomy (OE). Although the benefit of MIE for reducing morbidity and mortality rates is still under debate, a shorter hospital stay was common among the studies. The oncologic outcomes of MIE were not inferior to OE, while the number of retrieved lymph nodes was greater in MIE than OE in several studies.

Conclusion

Total MIE using a combined thoracoscopic and laparoscopic approach can be performed safely, although the benefits for short-term outcomes are still controversial. Oncologic outcomes are favorable and MIE may have an advantage in lymph node dissection over OE. The benefits of MIE should therefore be confirmed by randomized controlled trials.     

全胸腔镜肺叶切除术治疗周围型肺癌的临床分析

目的探讨全胸腔镜肺叶切除术在治疗周围型肺癌患者中的应用。方法回顾性分析2009年7月至2011年12月安徽医科大学附属省立医院应用全胸腔镜肺叶切除术治疗90例周围型肺癌患者的临床资料,其中男55例,女35例;年龄33～79(62.5±11.5)岁。观察术中淋巴结清扫组数、手术时间、术中出血量、术后胸腔引流时间、术后住院时间、并发症发生率和疼痛评分。结果围术期无死亡。手术时间(135.0±32.5)min,术中出血量(230.0±80.4)ml,术后胸腔引流时间(4.8±2.1)d,术后第3 d疼痛评分(5.3±1.2)分。共清扫淋巴结520组,1 568枚,5.8组/例、17.4枚/例;淋巴结有转移71组,阳性率13.7%(71/520)。术后发生声音嘶哑2例;乳糜胸3例,经相应的治疗均治愈。随访90例,随访时间1～24个月,随访期间因肿瘤转移死亡4例;其余生存患者生活质量良好。结论对周围型肺癌患者采用全胸腔镜肺叶切除术治疗,具有创伤小、恢复快和疼痛轻等优点。手术安全性、根治性与开胸手术相似,可作为治疗周围型肺癌患者的手术方式。     

Endoscopic Tumor Length Is an Independent Prognostic Factor in Esophageal Squamous Cell Carcinoma

Purpose

To investigate the impact of endoscopic esophageal tumor length on survival for patients with resected esophageal squamous cell carcinoma (ESCC).

Methods

We retrospectively reviewed the clinicopathologic characteristics of 244 ESCC patients who underwent curative resection as the primary treatment at Taipei Veterans General Hospital between January 2000 and November 2010. The endoscopic tumor length was defined as a uniform measurement before completion of the esophagectomy. The impact of endoscopic tumor length on a patient??s overall survival (OS) and disease-free survival (DFS) were assessed. A Cox regression model was used to identify prognostic factors.

Results

The 1-, 3-, and 5-year OS rates were 81.2, 48.2, and 39.6%, respectively, with a median survival time of 18.0?months. The 1-, 3-, and 5-year DFS rates were 66.2, 34.7, and 32.4%, respectively, with a median DFS of 15.0?months. Endoscopic tumor length correlated with pathologic tumor length [Pearson correction (r)?=?0.621; P?4?cm to identify patients with decreased long-term survival. In multivariate survival analysis, endoscopic tumor length (more or less than 4?cm) remained an independent prognostic factor for both OS (P?=?0.006) and DFS (P?=?0.002).

Conclusions

Endoscopic tumor length could have a significant impact on both the OS and DFS of patients with resected ESCC and may provide additional prognostic value to the current tumor, node, and metastasis staging system before patients receive any cancer-specific treatment.