ABSTRACT
<p><b>OBJECTIVE</b>To discuss the safety and feasibility of gastric tube in construction technique in total thoracoscopic and laparoscopic Ivor-Lewis esophagectomy.</p><p><b>METHODS</b>Clinical data of 358 patients with esophageal cancer who underwent the Ivor-Lewis procedure by the same surgical team in our department from June 2015 to June 2016 were retrospectively analyzed. Patients were divided into two groups: group MI (mini-incision): 92 patients undergoing extracorporeally gastric tube through a 4-cm abdominal mini-incision after gastric mobilization; group TL (total laparoscopy): 266 patients undergoing gastric tube made by total laparoscopy and jejunostomy. Intra-operative and postoperative data were compared between two groups.</p><p><b>RESULTS</b>Of 358 patients, 290 were male and 68 were female. The average age was (62.3±15.6) years. The tumor location ratio of group TL and group MI was 27.1%(72/266) and 25.0%(23/92) in middle thoracic esophageal cancer, 35.3%(94/266) and 34.8%(32/92) in mid-lower thoracic esophageal cancer, and 37.6%(100/266) and 40.2%(37/92) in lower thoracic esophageal cancer, respectively. In group TL and group MI, 42.1% (112/266) and 46.7%(43/92) patients were stage I( to II(a; 57.9%(154/266) and 53.3%(49/92) patients were stage II(b to III(a, respectively. All the patients from two groups received successful Ivor-Lewis esophagectomy. There were no significant differences between group TL and MI in operative time [abdominal operative time: (65.6±25.8) min vs. (62.3±25.6) min; thoracic operative time: (180.3±37.4) min vs. (178.1±39.2) min; time of making gastric tube:(16.1±3.2) min vs.(15.7±3.5) min], blood loss [abdominal: (60.5±19.8) ml vs. (62.3±20.9) ml; thoracic: (228.7±47.3) ml vs. (231.6±46.8) ml], and the number of lymph nodes dissection (abdominal: 8.9±1.8 vs. 8.7±1.6; mediastinal: 21.2±3.6 vs. 20.8±3.8)(all P>0.05). And there were no significant differences in occurrence of postoperative anastomotic leakage [4.5%(12/266) vs. 4.3%(4/92), χ=0.845, P=0.948], postoperative hospital stay [(12.2±4.8) d vs. (13.1±5.1) d, t=1.525, P=0.128] and average hospitalization cost(5.5±2.1 vs. 5.3±1.2, t=0.865, P=0.172) (ten thousand yuan, RMB) between group TL and MI.</p><p><b>CONCLUSION</b>During minimally invasive Ivor-Lewis esophagectomy, gastric tube by total laparoscopy is safe and reliable.</p>
ABSTRACT
Objective To compare the results and safety between video-assisted thoracoscopic surgery ( VATS ) and conventional radical operation in patients with stage Ⅰ , Ⅱ esophageal cancer. Methods Retrospectively reviewed 43 patients with stage Ⅰ , Ⅱ esophageal cancer,underwent either VATS radical operation (VATS group,16 cases) or conventional radical operation (control group,27 cases ) from September 2007 to September 2009. Patient's operative characteristics and postoperative courses were compared between two groups. Results In VATS group the operation time was ( 115.6 ± 48.0) min,the peri-operative blood loss was ( 131 ± 71 ) ml,the first postoperative day chest lead quantity was (331 ± 170)ml, the time of postoperative chest tube was (7.25 ± 2.35) d,the postoperative 36 h visual analogue scale (VAS) was (3.4 ± 1.2) scores,the postoperative drainage of chest was ( 1281 ± 534) ml,the 72 h postoperative locomotor activity of right upper extremity was (5.1 ± 1.5) cm. While in control group was ( 145.6 ± 20.6)min, (292 ± 111 ) ml, (494 ± 194) ml, ( 10.00 ± 2.79 )d, (7.3 ± 1.4) scores, ( 1780 ± 731 ) ml, ( 15.6 ± 3.1 )cm respectively (P ＜ 0.01 or ＜ 0.05 ). The lymph node dissection number,the total cost of hospital between were no statistically significant differences in two groups (P ＞0.05). Conclusion Comparing with conventional radical operation, VATS radical operation for patients with stage Ⅰ , Ⅱ esophageal cancer appears to be as effective but less morbid.
