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@#Objective To explore the application value of prognostic nutritional index (PNI) in the postoperative complications of McKeown surgery for da Vinci robotic esophageal cancer. Methods The clinical data of the patients who underwent da Vinci robotic McKeown surgery for esophageal cancer in the Department of Thoracic Surgery of the First Hospital of Lanzhou University from January 2019 to June 2022 were retrospectively collected. According to the receiver operating characteristic (ROC) curve, the optimal cut-off value of PNI for predicting postoperative complications was explored. The patients were divided into a high PNI group and a low PNI group according to the cut-off value, and the differences in basic characteristics, surgery-related indexes and postoperative complications between the two groups were analyzed. According to the occurrence of postoperative complications, the patients were divided into a non-complication group and a complication group. Univariate and multivariate analyses were used to explore the influence of relevant indicators on the occurrence of postoperative complications in da Vinci robotic McKeown surgery for esophageal cancer. Results Finally 120 patients were collected, including 95 males and 25 females, with an average age of 62.82 years. The preoperative hemoglobin content, preoperative blood lymphocyte count, preoperative serum albumin and preoperative blood total cholesterol in the high PNI group were higher than those in the low PNI group (P<0.05). There were statistical differences between the two groups in the incidences of postoperative overall complications, pulmonary infection, pleural effusion and poor incision healing (P<0.05). The relevant indicators that may cause postoperative complications were included in univariate analysis, and the results showed that age, operation time, intraoperative blood loss, preoperative blood lymphocyte count, preoperative hemoglobin content, preoperative blood mononuclear cell count, preoperative blood monocyte count, serum albumin level and PNI were possible influencing factors of postoperative complications after da Vinci robotic McKeown surgery for esophageal cancer. Incorporating these influencing factors into multivariate analysis, the results showed that age, PNI, operation time and intraoperative blood loss were independent influencing factors of postoperative complications. Conclusion PNI has certain predictive value in the postoperative complications of da Vinci robotic McKeown surgery for esophageal cancer. PNI is an independent factor affecting postoperative complications. Improving the level of PNI in esophageal cancer patient before surgery may help reduce the occurrence of postoperative complications.
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@#Objective To investigate the application of enhanced recovery after surgery (ERAS) in da Vinci robotic McKeown surgery for esophageal cancer. Methods Clinical data of patients admitted to the First Hospital of Lanzhou University and undergoing da Vinci robotic McKeown surgery for esophageal cancer from 2017 to 2021 were retrospectively analyzed. According to the treatment, they were divided into two groups, a conventional group and an ERAS group. Patients in the conventional group were treated with the conventional perioperative treatment mode of thoracic surgery, and patients in the ERAS group were treated with accelerated rehabilitation surgical treatment mode. Relevant hospitalization indicators and postoperative complication rates were compared between the two groups. Results Finally 128 patients were collected, including 106 males and 22 females, with an average age of 61.91 years. There were 71 patients in the conventional group and 57 patients in the ERAS group. The postoperative pain index in the ERAS group was significantly lower than that in the conventional group (P<0.05), and the duration of postoperative analgesic pump used in the ERAS group was shorter than that in the conventional group (2.39±0.49 d vs. 3.13±0.63 d, P<0.001). There was no statistical difference in the incidence of postoperative related complications (gastroesophageal reflux, anastomotic stenosis, anastomotic fistula, arrhythmia, recurrent laryngeal nerve injury, chylothorax, anastomosis stomatitis or incisional infection) between the two groups (P>0.05), but the incidence of postoperative lung infection in the ERAS group was statistically lower (12.28% vs. 26.76%, P=0.043), and the volume of postoperative pleural effusion was statistically less compared with the conventional group (P<0.05). In the ERAS group, the surgery time (294.35±15.19 min vs. 322.79±59.09 min, P<0.001), postoperative exhaust time (1.44±0.39 d vs. 1.94±0.43 d, P<0.001), postoperative removal time of nasolasal tube (6.79±0.73 d vs. 8.21±0.86 d, P<0.001), hospital stay (19.88±3.36 d vs. 21.34±3.59 d, P=0.020), hospitalization costs (105 575.28±8 960.75 yuan vs. 137 894.64±19 518.60 yuan, P<0.001) were all lower or shorter than those of the conventional group. Postoperative activity was longer in the ERAS group than that in the conventional group (P<0.05), but there was no statistical difference in preoperative anesthesia time between the two groups (P=0.841). Conclusion The application of ERAS in da Vinci robotic McKeown surgery for esophageal cancer can effectively alleviate the physiological and psychological burden of patients, reduce the occurrence of postoperative related complications, effectively shorten the total hospital stay, save hospitalization costs, and reduce the economic burden of patients and society. Therefore, it can be promoted and applied in the clinic.
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Objective To investigate the application value of root seeking method and suspension method in lymph nodes dissection of recurrent laryngeal nerve (RLN) during minimally invasive McKeown surgery of thoracic esophageal cancer.Methods The retrospective cohort study was conducted.The clinical data of 120 patients with thoracic esophageal cancer who were admitted to the First Affiliated Hospital of Zhengzhou University from March 2015 to May 2016 were collected.Sixty patients using root seeking method and suspension method in lymph nodes dissection of RLN were allocated into the study group,and 60 using unexposed lymph nodes dissection of RLN were allocated into the control group.All the patients underwent minimally invasive McKeown surgeries.Observation indicators:(1) intraoperative situations;(2) postoperative situations;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative tumor recurrence or metastasis and injury of RLN up to January 2017.Measurement data with normal distribution were represented as-x±s.Comparisons between groups were evaluated with the independent-sample t test.Count data were analyzed using the chi-square test.Results (1) Intraoperative situations:patients between groups underwent successful minimally invasive McKeown surgery,without conversion to open surgery.The operation time and volume of intraoperative blood loss were respectively (250± 19)minutes,(484±80)mL in the study group and (248±22) minutes,(493±60)mL in the control group,with no statistically significant difference between groups (t =0.532,-0.697,P＞0.05).The number of lymph nodes dissection,successful dissection rate and metastasis rate in the left RLN and metastasis rate in the right RLN were respectively 5.0±4.1,86.7％ (52/60),23.3％ (14/60),16.7％ (10/60) in the study group and 1.0±0.9,60.0％ (36/60),1.7％ (1/60),5.0％ (3/60) in the control group,with statistically significant differences between groups (t =5.170,x2=10.909,12.876,4.227,P＜0.05).The number of lymph nodes dissection,successful dissection rate and metastasis degree in the right RLN and metastasis degree in the left RLN were respectively 3.5±3.6,93.3％(56/60),8.55％(20/234),7.69％ (20/260) in the study group and 1.5± 1.0,83.3％ (50/60),4.00％ (4/100),1.72％ (1/58) in the control group,with no statistically significant difference between groups (t=1.075,x2 =2.911,2.172,1.856,P＞0.05).(2) Postoperative situations:time to initial anal exsufflation,time of initial defecation and time for initial fluid diet intake were respectively (2.0±0.6)days,(3.1 ± 0.6)days,(7.2± 0.3)days in the study group and (2.2±0.8) days,(3.2±0.5) days,(6.9±0.5) days in the control group,with no statistically significant difference between groups (t=2.618,-0.991,3.985,P＞0.05).Comparisons of injury degree of RLN:5 and 1 patients in the study and control groups had mild injury,respectively,showing no statistically significant difference between groups (x2=1.581,P＞0.05);1 and 8 patients in the study and control groups had respectively moderate injury,showing a statistically significant difference between groups (x2 =4.323,P＜0.05);there was no severe injury between groups.Duration of hospital stay in the study and control groups were respectively (14.8±2.5)days and (14.5±2.8) days,showing no statistically significant difference between groups (t =0.619,P＞ 0.05).(3)Follow-up:120 patients were followed up for 4-22 months,with a median time of 13 months.During the follow-up,3 and 2 patients in the study and control groups had cervical lymph node metastases and received postoperative assisted chemotherapy and local radiotherapy of neck,without death between groups.There was no hoarseness in 6 patients with mild injury of RLN during the follow-up;voices in 9 patients with moderate injury of RLN were improved at 1-2 months postoperatively,and no bucking symptom was detected after fluid diet intake.Conclusion The root seeking method and suspension method in lymph nodes dissection of RLN is safe and effective during minimally invasive McKeown surgery of thoracic esophageal cancer,especially conducive to lymph nodes exposure and dissection of the left RLN,and reduce the incidence of moderate injury of RLN.