ABSTRACT
Objective To investigate the clinical value of combined thoracoscopic and laparoscopic esophagectomy for the treatment of esophageal carcinoma.Methods The clinical data of 50 patients who underwent combined thoracoscopic and laparoscopic for the treatment of esophageal carcinoma at the Jiangdu People's Hospital of Yangzhou from May 2013 to August 2014 were retrospectively analyzed.The patients underwent the thoracoscopic mobilization of the intrathoracic esophagus and lymph node dissection in the left lateral decubitus position, and then the patients underwent laparoscopic mobilization of the stomach and lymph node dissection in the horizontal position, finally the gastric tube was pulled out to have stapled anastomosis through left neck.The operation time, volume of intraoperative blood loss, number of lymph node dissected, amount of postoperative thoracic drainage, time to resume diet after surgery, postoperative hospital stay and results of pathological examination were collected.Patients were followed up via telephone interview and out-patient examination till September 2014.The recovery condition and survival of patients were collected.The measurement data with normal distribution were presented as (x) ± s or mean value (range).Results There was no patient transferred to open thoracic surgery or abdominal surgery.The operation time of thoracoscopic and laparoscopic procedures were (85 ±30)minutes and (55 ± 22) minutes, respectively.The total operation time was (210 ± 40) minutes.The mean volume of intraoperative blood loss was 115 mL (range, 50-210 mL) in the thoracic cavity and 65 mL (range, 30-100 mL) in the abdomen.The mean number of lymph nodes dissected was 11.3 (range, 8.0-15.0) in the thoracic cavity and 8.5 (range, 6.0-12.0) in the abdomen.The mean volume of postoperative thoracic drainage, mean time to resume diet and postoperative hospital stay were 340 mL (range, 200-650 mL) , 7 days (range, 6-8 days) and 12 days (range, 11-14 days).The 50 cases were diagnosed as esophageal squamous cell cancer and staged as T1-3N0-1M0 by postoperative pathological examination, with negative upper and lower margin.There was 1 case of anastomotic leak, 3 cases of lung infection who were cured by symptomatic treatment and 3 cases of recurrent laryngeal nerve injury after operation who recovered after 6-month follow-up.All patients were successfully followed up without recurrence and death.During the follow-up of 1-16 months, 2 patients were found anastomotic stricture at postoperative 3 months, and were cured by endoscopic dilation for 3 times.Conclusion Combined thoracoscopic and laparoscopic esophagectomy is safe and effective for the treatment of esophageal carcinoma.
ABSTRACT
Objective To evaluate of safety and feasibility of thoracoscopic and laparoscopic esophagec -tomy for the treatment of esophageal carcinoma .Methods Retrospective analyses were performed on chest com-bined with laparoscopy in the treatment of 20 patients with esophageal cancer information from september 2013 to July 2014 .The patients were placed at a left lateral decubitus position ,with the thoracoscopic mobilization of the intrathoracic esophagus and lymph node dissection;then in the lithotomy position .Laparoscopic mobilization of the stomach and lymph node dissection were cleared .Finally we pulled out the gastric tube from the esophageal bed to the neck and made stapled esophagogastrostomy in the left neck .Results All patients were not to be opened tho-racic surgery and abdominal surgery .The mean operation time for thoracoscopy was (90 ±30)minutes,The mean operation time for laparoscopic was(65 ±20)minutes,The total operation time was(210 ±40)minutes.The tho-racic blood loss ranged from 60 to 200 mL( mean,110 mL) ,The abdominal blood loss ranged from 30 to 100 mL (mean,60 mL).mean number of mediastinal lymph nodes resected was ranged from 8 to 15(11.2 per ease), mean number of abdominal lymph nodes resected was ranged from 6 to 12(8.4 per ease).Postoperative thoracic drainage was ranged from 200 to 650 mL( mean,350 mL) .mean time to resume oral intake was ranged from 6 to 8 days(mean,7 days),mean postoperative hospital stay was ranged from 11 to 14 days(mean,12 days),All the patients were diagnosis for esophageal squamous cell cancer after operation .Postoperative pathologicalcat staging identified stage T 1~3 N0~1 M0 .There was not tumor at the upper rejection margin and the lower margin .There was not anastomotic leak in postoperative .Postoperative lung infection in1 case.Postoperative recurrent laryngeal nerve injury in 1case.It was successfully followed up with durations 6 months.anastomotie stricture in 1 case after post-operative 3 months,And in endoscopic probe dilatation for patients with anastomotie stricture was successful in three times.20 cases were successfully followed up with durations ranged from 2 to 10 months.There was not spreaded and died in cases .Conclusion Combined thoracoscopic and laparoscopic esophagectomy can reduce trauma and postoperative complications ,which is safe and feasible therapeutic method .