Wang Xiang, Li Qiang, Zhuang Xiang, Yang Xiaojun, Xie Tianpeng, Xiao Ping, Ma Ke, Hu Bin
Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China.
Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China. Email:
Zhonghua Zhong Liu Za Zhi. 2014 Nov;36(11):863-6.
Thoracoscopic esophagectomy has gained worldwide popularity. This study compared the perioperative outcomes and lymphadenectomy after thoracoscopic esophagectomy in semi prone position and open esophagectomy.
Sixty-two consecutive patients after thoracoscopic esophagectomy were compared with 62 patients who underwent open esophagectomy. Outcomes included surgical time, blood loss, length of hospital stay, 30-day mortality, complications and gained lymph nodes.
The mean length of hospital stay of the thoracoscopic group was 12.4 ± 7.4 days, and 13.6 ± 6.7 days in the open esophagectomy group (P > 0.05). The median total operation time and median thoracic operation time were 270 and 130 min, the median total blood loss and median thoracic blood loss were 300 and 180 ml in the thoracoscopic group, while the results in open esophagectomy group were 290, 150 min and 300, 180 ml. The median total operation time and median thoracic operation time were of statistically significant difference (P < 0.01). But there were no significant differences between the two groups in total blood loss and thoracic blood loss (P > 0.05) . The numbers of obtained lymph nodes in the thoracoscopic group and open esophagectomy group were 20.5 and 16.9 (P < 0.01). Among them, the median numbers of mediastinal lymph nodes in the thoracoscopic group and open esophagectomy group were 12.4 and 8.8, the left recurrent laryngeal nerve lymph nodes were 1.8 and 1.0, and the right recurrent laryngeal nerve lymph nodes were 2.9 and 1.2 (P < 0.01 for all). There were 8 positive recurrent laryngeal nerve lymph nodes (12.9%) in the thoracoscopic group, while 5 in the open esophagectomy group (8.1%, P > 0.05). There were no peri-operative period death, heavy bleeding, or thoracic gastric fistula in both groups.
Thoracoscopic esophagectomy in semi prone position may achieve good surgical field exposure, therefore, to make esophagectomy, lymph node dissection and digestive tract reconstruction possible. These findings suggest that with further technical refinement, thoracoscopic esophagectomy may have the upper hand on reducing postoperative complications and performing mediastinal lymph node dissection.
电视胸腔镜下食管癌切除术已在全球范围内得到广泛应用。本研究比较了半俯卧位电视胸腔镜下食管癌切除术与开放食管癌切除术的围手术期结果及淋巴结清扫情况。
连续纳入62例行电视胸腔镜下食管癌切除术的患者，并与62例行开放食管癌切除术的患者进行比较。观察指标包括手术时间、出血量、住院时间、30天死亡率、并发症及获取的淋巴结数量。
电视胸腔镜组的平均住院时间为12.4±7.4天，开放食管癌切除术组为13.6±6.7天（P>0.05）。电视胸腔镜组的总手术时间中位数和胸部手术时间中位数分别为270分钟和130分钟，总出血量中位数和胸部出血量中位数分别为300毫升和180毫升；开放食管癌切除术组的结果分别为290分钟、150分钟和300毫升、180毫升。总手术时间中位数和胸部手术时间中位数差异有统计学意义（P<0.01）。但两组的总出血量和胸部出血量差异无统计学意义（P>0.05）。电视胸腔镜组和开放食管癌切除术组获取的淋巴结数量分别为20.5枚和16.9枚（P<0.01）。其中，电视胸腔镜组和开放食管癌切除术组的纵隔淋巴结中位数分别为12.4枚和8.8枚，左侧喉返神经旁淋巴结分别为1.8枚和1.0枚，右侧喉返神经旁淋巴结分别为2.9枚和1.2枚（均P<0.01）。电视胸腔镜组有8枚喉返神经旁淋巴结阳性（12.9%），开放食管癌切除术组有5枚（8.1%，P>0.05）。两组均无围手术期死亡、大出血或胸胃瘘发生。
半俯卧位电视胸腔镜下食管癌切除术可获得良好的手术视野暴露，从而使食管癌切除、淋巴结清扫及消化道重建成为可能。这些结果表明，随着技术的进一步完善，电视胸腔镜下食管癌切除术在减少术后并发症及进行纵隔淋巴结清扫方面可能更具优势。
