不同微创路径下食管癌根治术的临床疗效分析OA

Objective·To evaluate and compare the efficacy of three types of radical esophagectomy for esophageal cancer.Methods·The clinical data of 298 patients who underwent radical esophagectomy were retrospectively analyzed.The patients were divided into three groups based on the surgical approach:the synchronous insufflation mediastinoscopy with laparoscopy esophagectomy(SIMLE)group,the combined insufflation mediastinoscopy-laparoscopy esophagectomy(CIMLE)group,and the McKeown group.Propensity score matching(PSM)was performed at a 1∶1 ratio for pairwise stratification matching between groups.Differences among the groups were analyzed in terms of preoperative baseline data,operative time,intraoperative blood loss,indicators of internal homeostasis,postoperative complications,number of lymph nodes dissected,and postoperative recovery status.Results·After PSM,75 pairs were matched between the SIMLE and CIMLE groups,and 88 pairs between the SIMLE and McKeown groups.Operative time and intraoperative blood loss in the SIMLE group were significantly lower than those in the CIMLE and McKeown groups(all P<0.001).At the end of anesthesia induction,indicators of internal homeostasis,including pH value,glucose,base excess,and lactate levels,in the SIMLE group were superior to those in the CIMLE and McKeown groups(all P<0.05).The SIMLE group also showed better outcomes than the other two groups in terms of complications such as anastomotic leakage and anastomotic stricture(P<0.05).The postoperative hospital stay in the SIMLE group was shorter than that in the CIMLE and McKeown groups(both P<0.001).At 7 days postoperatively,levels of interleukin-6,tumor necrosis factor-ɑ,and C-reactive protein in the SIMLE group were significantly lower than those in the CIMLE and McKeown groups(all P<0.05).At 14 days postoperatively,recovery of prealbumin and albumin levels was better in the SIMLE group(all P<0.05).Within 1 month after surgery,the SIMLE group had significantly higher scores on the 15-item Quality of Recovery-15(QoR-15)scale compared to the CIMLE and McKeown groups(all P<0.05).Conclusion·The SIMLE procedure,through synchronous operation using mediastinoscopy and laparoscopy,can shorten operative time,reduce surgical stress,and accelerate postoperative recovery,providing a new minimally invasive treatment option for patients with esophageal cancer.