Akaishi T, Kaneda I, Higuchi N, Kuriya Y, Kuramoto J, Toyoda T, Wakabayashi A
Second Department of Surgery, Tohoku University School of Medicine, Sendai, Japan.
J Thorac Cardiovasc Surg. 1996 Dec;112(6):1533-40; discussion 1540-1. doi: 10.1016/s0022-5223(96)70012-0.
Total esophagectomy with en bloc mediastinal lymphadenectomy for cancer carries a substantial morbidity and mortality rate. To investigate the feasibility of thoracoscopic technique, we carried out an extensive laboratory study. Encouraged by our excellent results, we conducted a clinical trial.
From September 1994 to September 1995, 39 patients thoracic esophageal cancer lesions not invading surrounding organs underwent total esophagectomy with mediastinal lymphadenectomy by means of thoracoscopy. Ages ranged from 47 to 86 years. The procedures were conventional except for the thoracic portion, which was performed as a thoracoscopic procedure with six trocar holes instead of thoracotomy. All harvested lymph nodes were counted for each station. Spirometric data and plethysmographically determined vital capacity were measured before and after operation for all patients.
All procedures were accomplished as scheduled, and none was converted to open thoracotomy. The operating time was 200 +/- 41 minutes (mean +/- standard deviation). Estimated blood loss was 270 +/- 157 ml. The harvested lymph nodes numbered 19.7 +/- 11.1 per patient. Seventeen patients (45%) had positive lymph nodes. There were no in-hospital deaths within 30 days. Twenty-two patients did not require postoperative ventilatory support. Vital capacity decreased to 85% +/- 11% of the preoperative values, and forced expiratory volume in 1 second decreased to 82% +/- 16%.
Thoracoscopic mediastinal lymphadenectomy is technically feasible, and its completeness is comparable to that of the open technique. The decline in pulmonary function is significantly less than that seen in our previous experience with the open technique.
食管癌整块切除并纵隔淋巴结清扫术具有较高的发病率和死亡率。为研究胸腔镜技术的可行性，我们开展了一项广泛的实验室研究。鉴于取得的优异结果，我们进行了一项临床试验。
1994年9月至1995年9月，39例胸段食管癌未侵犯周围器官的患者接受了胸腔镜下食管癌整块切除及纵隔淋巴结清扫术。年龄范围为47至86岁。除胸段手术采用胸腔镜操作（六个套管孔而非开胸手术）外，其余手术步骤均为常规操作。对每个分站所采集的淋巴结进行计数。对所有患者在手术前后测量肺量计数据和体积描记法测定的肺活量。
所有手术均按计划完成，无一例转为开胸手术。手术时间为200±41分钟（平均±标准差）。估计失血量为270±157毫升。每位患者采集的淋巴结数为19.7±11.1个。17例患者（45%）有阳性淋巴结。30天内无院内死亡病例。22例患者术后无需通气支持。肺活量降至术前值的85%±11%，第一秒用力呼气量降至82%±16%。
胸腔镜纵隔淋巴结清扫术在技术上是可行的，其彻底性与开放技术相当。肺功能的下降明显小于我们之前开放技术的经验所见。
