Outcomes of Advanced Oncological Laparoscopic Procedures in a Tertiary Care Center

Introduction: Advanced laparoscopic procedures are performed in oncology for almost all visceral sites. We present theoncological and functional outcomes of series of patients who underwent advanced laparoscopic oncological procedures inour tertiary care center.Materials and Methods: We analyzed 34 consecutive patients who underwent advanced laparoscopic oncological proceduresby the same surgeon in the department of surgical oncology during the period of 2015–2019. Five patients underwentlaparoscopic type C1 radical hysterectomy. Laparoscopic abdominoperineal resection was done for six patients, laparoscopicstaging for carcinoma endometrium for seven patients, thoracoscopic esophagectomy for five patients, laparoscopic-assisteddistal gastrectomy for two patients, and laparoscopic staging for ovarian cancer for four patients. Laparoscopic right radicalnephrectomy and laparoscopic right hemicolectomy were done for one patient each.Results: Out of the five patients who underwent laparoscopic Type C1 radical hysterectomy, one patient had residual IB1disease. There was no bladder morbidity and all patients are alive without disease. Two patients who underwent laparoscopicabdominoperineal resection and one patient after thoracoscopic esophagectomy developed disease recurrence. None of thepatients who underwent other procedures had major morbidity or disease recurrence.Conclusion: Advanced laparoscopic procedures are feasible in oncology with minimal morbidity and good oncological outcome.The nodal yield and oncological outcome improve with increasing experience of the surgeon in minimally invasive surgicaloncology.

Clinical differences between artificial pneumothorax and double lumen intubation in thoracoscopic esophagectomy / 局解手术学杂志

Objective To explore the advantages and disadvantages of the double lumen endotracheal intubation and single -lumen endo-tracheal intubation and continuous carbon dioxide insufflation in thoracoscopic esophagectomy .Methods The clinical data of 90 patients in our department of thoracic surgery after thoracoscopic esophagectomy from January 2014 to April 2015 were analyzed .All patients were divid-ed into single-lumen endotracheal intubation (group A)and double lumen endotracheal intubation group (group B).The endotracheal intuba-tion time,operation time,incidence of pulmonary infection,intraoperative and postoperative PaO2,PaCO2,incidence of anastomotic fistula, hospitalization expenses ,length of hospital stay and the incidence of postoperative chylothorax between two groups were compared .Results The difference in intraoperative PaO2,PaCO2,incidence of pulmonary infection,endotracheal intubation time,operation time,hospitalization days and the hospitalization cost between two groups were statistical significance .The difference of the rest index between two groups were no statistical significance.Conclusion Group A has certain advantages in perioperative management ,hospitalization cost and so on,but has disadvantages in perioperative hypoxemia and carbon dioxide retention and acid -base balance disorders .

THORACOSCOPIC ESOPHAGECTOMY FOR ESOPHAGEAL CANCER / 解放军医学杂志

Thoracoscopic esophagectomy is an alternative to open thoracotomy in treatment of esophageal carcinoma, but its role in esophageal surgery is still controversial. Between May 2000 and May 2002, 9 patients affected by esophageal carcinoma underwent esophagectomy with thoracoscopic dissection of the esophagus. Seven patients were male, 2 were female,and the mean age was 51 (range, 42～56) years.One patient had the carcinoma at cervical segment, 2 at upper third thoracic segment, 5 at middle third, and 1 at lower third.All tumors were squamous cell type and were below stage II.Thoracoscopy and cervical esophagogastrostomy were successfully performed in 8 patients except in one case, in whom conversion to thoracotomy was necessary because of extensive tumor invasion.Thoracoscopic dissection took an average of 70 (range,40～120) minutes and the mean operative time was 252(range,230～270) minutes. the mean operative blood loss was 250ml (range,150～400ml) and the mean number of thoracic lymph nodes harvested was 7(range,5～12).One patient experienced a cervical infection,which healed with conservative treatment.One patient had a temporary left recurrent nerve palsy that disappeared during the following 6 months.These initial data indicate that thoracoscopic esophagectomy is safe and feasible. The short term result of thoracoscopy is comparable with that of open thoracotomy, and the long term result and its role in esophageal surgery deserve further investigation.