ASCO GI 2015 ：MIRO研究：可切除食管癌行混合微创食管切除术有短期获益

2015-01-22 黄蕾蕾中国医学论坛报

MIRO研究：食管癌患者混合微创和开放性食管切除术比较(摘要号：5) 报告者：Christophe Mariette 报告时间：旧金山时间1月15日，2:00 pm~3:30 pm 研究背景：外科手术被认为是可切除食管癌的唯一治疗选择。术后并发症，特别是肺部并发症，仍然是引起诸多关注的焦点，一半以上行开放性食管切除术(OO)的患者出现并发症。本研究对混合微创食管切除术(HMIO)与OO进行比

MIRO研究：食管癌患者混合微创和开放性食管切除术比较(摘要号：5)

报告者：Christophe Mariette

报告时间：旧金山时间1月15日，2:00 pm~3:30 pm

研究背景：外科手术被认为是可切除食管癌的唯一治疗选择。术后并发症，特别是肺部并发症，仍然是引起诸多关注的焦点，一半以上行开放性食管切除术(OO)的患者出现并发症。本研究对混合微创食管切除术(HMIO)与OO进行比较，评价其是否减少并发症的发生。

研究方法：这是一项多中心、非盲、随机对照研究，以2009年10月至2012年4月12家研究中心18~75岁、中段或下1/3段可切除食管癌患者为研究对象，根据计算机生成随机序列分别行经胸廓的OO或HMIO，随机化按研究中心分层。主要研究终点是术后30天Ⅱ~Ⅳ级并发症(手术并发症分级参照Dindo-Clavien分类法)。研究采用意向性分析。

研究结果：共207例患者接受手术，其中OO组104例，HMIO组103例。OO组中有67例(64.4%)患者出现主要术后并发症，HMIO组有37例(35.9%)，比值比(OR)为0.31(95%CI：0.18~0.55，P=0.0001)。OO组和HMIO组分别发生主要肺部并发症31例(30.1%)和18例(17.7%)(P=0.037)，而术后30天死亡率分别为5例(4.9%)和5例(4.9%)。

研究结论：这一研究结果为可切除食管癌患者行HMIO的短期获益提供证据。

专家点评

主要研究者、法国Claude Huriez大学医院Christophe Mariette：这些结果为HMIO应用于可切除食管癌患者提供了有力的证据。我们认为应该考虑将HIMO作为食管癌手术治疗的一项新的标准方法。

美国Beth Israel Deaconess医学中心、哈佛医学院Michael S. Kent：我认为，微创治疗应该成为这一疾病(可切除食管癌)的标准治疗方案。现在面临的主要挑战是推广如何在其他中心安全开展这项手术，据我所知这是一项有技术要求的手术。另外，手术的操作细节如吻合口的定位、开胸术是否优于胸腔镜等仍未被解决。

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2015-05-17 doctorzheng

#切除术#

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2015-11-16 quxin068

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2015-09-19 smallant2002

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2015-02-21 ms7474195563676018

#食管切除术#

78 0
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2015-01-24 vera_1203

#微创#

76 0
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2015-01-24 zhouqu_8

#食管#

68 0

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