微创经颈食管切除术（MICE）与经胸微创食管切除术（TMIE）术后并发症比较：一项逆概率治疗加权分析

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中文摘要

背景： 微创经颈食管切除术（MICE）是一种新技术，可进行根治性淋巴结清扫，避免经胸入路，可能保留胸膜完整性并避免单肺通气，从而减少术后肺部并发症。然而，其相对于传统经胸微创食管切除术（TMIE）的优势仍不明确。本研究的目的是评估TMIE和MICE术后的结局。方法：开展了一项回顾性队列研究，纳入2020年至2024年间在荷兰Radboudumc接受食管切除术的可切除食管癌患者（cT1-4aN0-3M0）。主要结局是30天内术后并发症的发生率。采用逆概率治疗加权（IPTW）来校正组间混杂。结果：共纳入115例MICE和172例TMIE患者。IPTW后，MICE术后总体并发症更常见（60.3% vs. 43.9%，RD：16.4%，95% CI：3.3-29.4）。这一差异主要由喉返神经麻痹（RLNP）发生率较高所致（MICE：30.4% vs. TMIE：0.0%）。肺部并发症（18.9% vs. 21.8%，RD：-2.9，95% CI：-17.1至12.5）或吻合口漏（5.6% vs. 8.1%，RD：-2.4%，95% CI：-11.5至7.3）未见统计学显著差异。结论：尽管MICE术后总体并发症发生率较高，但这一差异主要归因于喉返神经麻痹发生率增加，且多为暂时性，这与经颈入路不可避免相关。MICE和TMIE的肺炎和吻合口漏发生率相似。由于这些数据包含MICE开展早期阶段的病例，随着各手术团队经验积累，并发症发生率可能会改善。这些发现强调，在更广泛推广前需要进一步评估和优化MICE手术。

英文摘要

Minimally Invasive transCervical oEsophagectomy (MICE) is a novel technique with radical lymphadenectomy that avoids a transthoracic access, potentially preserving pleural integrity and obviating one lung ventilation, thereby reducing postoperative pulmonary complications. However, its advantages over conventional Transthoracic Minimally Invasive oEsophagectomy (TMIE) remain unclear. The objective of this study was to assess postoperative outcomes after TMIE and MICE. A retrospective cohort study was conducted including patients with resectable esophageal cancer (cT1-4aN0-3M0) who underwent esophagectomy at the Radboudumc, the Netherlands between 2020 and 2024. The primary outcome was the incidence of postoperative complications within 30 days. Inverse probability of treatment weighting (IPTW) was used to account for confounding between the groups. A total of 115 MICE and 172 TMIE patients were included. After IPTW, overall postoperative complications were more frequent after MICE (60.3% vs. 43.9%, RD: 16.4%, 95% CI: 3.3-29.4). This difference was predominantly driven by a higher incidence of recurrent laryngeal nerve palsy (RLNP) (MICE: 30.4% vs. TMIE: 0.0%). No statistical significant difference was observed in pulmonary complications (18.9% vs. 21.8%, RD: -2.9, 95% CI: -17.1 to 12.5) or anastomotic leakage (5.6% vs. 8.1%, RD: -2.4%, 95% CI: -11.5 to 7.3). Although overall postoperative complication rates were higher after MICE, this difference was mainly attributable to an increased incidence of mostly transient recurrent laryngeal nerve palsy, which is inevitably associated with the transcervical approach. Rates of pneumonia and anastomotic leakage were similar between MICE and TMIE. As these data include cases performed during the early experience with MICE, complication rates may improve as experience accumulates across surgical teams. These findings highlight the need for further evaluation and optimization of the MICE procedure prior to broader implementation.