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首页> 外文期刊>Surgical Endoscopy >Commentary on 'Uttley L, Campbell F, Rhodes M et al. Minimally invasive esophagectomy versus open surgery: is there an advantage? Surg Endosc 2013;27(3):724-731'.
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Commentary on 'Uttley L, Campbell F, Rhodes M et al. Minimally invasive esophagectomy versus open surgery: is there an advantage? Surg Endosc 2013;27(3):724-731'.

机译：评论“ Uttley L，Campbell F，Rhodes M等人。微创食管切除术与开放性手术：有优势吗？Surg Endosc 2013; 27（3）：724-731”。

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In their systematic review of open versus minimal access esophagectomy (MIO), Uttley et al. correctly conclude that due to factors such as selection bias, sufficient evidence does not exist to suggest the MIO is either equivalent to or superior to open surgery. However, they suggest that a randomized controlled trial (RCT) would be difficult to conduct for ethical reasons (e.g., variations in surgical skill between procedures and complex decision making in determining the optimal operative interventions) and that it would be time consuming due to recruitment issues. We agree that a RCT would pose particular issues, but it is the only way for a robust comparison of the two techniques. Although problems such as lack of blinding are difficult to change, control can be used for other factors, and current UK guidance on the comparison of complex surgical techniques is published by the Medical Research Council (MRC). The well-conducted MRC Conventional versus Laparo-scopic-Assisted Surgery In Colorectal Cancer (CLASICC) trial investigating laparoscopic versus open surgery for colorectal cancer is a good example of an RCT that examined complex interventions but successfully addressed the problems of balancing patient and surgeon factors, learning curve effects, and quality control. The surgical resection was not prescriptive but performed as per the surgeon's current practice, and randomization was stratified by the surgeon as well as other tumor-related variables.
机译：Uttley等人在他们的开放性与最小访问性食管切除术（MIO）的系统评价中。正确地得出结论，由于选择偏见等因素，没有足够的证据表明MIO等同于或优于开放手术。但是，他们认为，出于伦理原因（例如，手术技巧之间的差异以及确定最佳手术干预措施时的复杂决策），将难以进行随机对照试验（RCT），并且由于招募而耗时问题。我们同意RCT会带来一些特殊的问题，但这是对这两种技术进行可靠比较的唯一方法。尽管诸如盲目性之类的问题很难改变，但可以将控制因素用于其他因素，医学研究理事会（MRC）发布了英国目前有关复杂外科技术比较的指南。进行良好的MRC常规与大肠癌腹腔镜辅助外科手术（CLASICC）进行的大肠癌腹腔镜与开放性外科手术研究的临床试验是RCT的一个很好的例子，RCT检查了复杂的干预措施，但成功解决了平衡患者和外科医生因素的问题，学习曲线效果和质量控制。手术切除不是规定性的，而是按照外科医生目前的做法进行的，并且随机化由外科医生以及其他与肿瘤相关的变量进行分层。

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