Clinical Outcomes of Combined Complete Thoracoscopic and Laparoscopic Esophagectomy for Esophageal Carcinoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YAO Xiaojun , ZHANG Hongwei , ZHENG Xinglong , HU Xiang.

Department of Thoracic Surgery，Meishan Cancer Hospital，Meishan 620010，Sichuan，P. R. China;

Corresponding author：

Keywords：

Esophageal carcinoma; 　Thoracoscopy; 　Laparoscopy; 　Minimally invasive surgery

DOI：

10.7507/1007-4848.20130212

Video：

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Objective To explore the feasibility，safety and clinical applicability of combined complete thoracoscopicand laparoscopic esophagectomy for the treatment of esophageal carcinoma. Methods Clinical data of 34 patients with esophageal carcinoma who underwent combined complete thoracoscopic and laparoscopic esophagectomy in the Departmentof Thoracic Surgery of our hospital from January 2012 to June 2013 were analyzed retrospectively. There were 33 males and1 female with their age of 63 （41-76） years. Results One patient received conversion to laparotomy and 1 patient diedpostoperatively. Mean operation time was 362.1 （300-560） minutes，including 90.6 （60-220） minutes for thoracoscopicprocedure in 34 patients and 61.1 （45-85） minutes for laparoscopic procedure in 33 patients. Mean intraoperative blood loss was 206.5 （100-500） ml. Average number of dissected lymph nodes was 18.0 （13-31） for each patient with positivemetastatic rate of 44.1% （15/34）. Postoperative pathological diagnosis was squamous cell carcinoma in 33 patients and smallcell carcinoma in 1 patient. Postoperative pathological staging was stageⅠB in 1 patient，stageⅡA in 1 patient，stageⅡB in 15 patients，stageⅢA in 11 patients，stageⅢB in 3 patients and stageⅢC in 3 patients. Postoperative hospital stay was 15.2 （6-35） days. Two patients received bedside bronchoscopic sputum suction. Postoperative complications occurred in32.4% （11/34） of all patients，including pulmonary infection in 4 patients （11.8%），respiratory failure in 2 patients （5.9%），chylothorax in 1 patient （2.9%），cervical anastomotic leak in 4 patients （11.8%） and hoarseness in 2 patients （5.9%）. We followed up 33 patients for 1-16 months. Two died，Two were lost. The other 29 patients survived. Conclusion Combined complete thoracoscopic and laparoscopic esophagectomy is a minimally invasive，feasible and safe surgical procedure for the treatment of esophageal carcinoma with quick postoperative recovery，and is worthy of furtherclinical application.

Citation： YAO Xiaojun,ZHANG Hongwei,ZHENG Xinglong,HU Xiang.. Clinical Outcomes of Combined Complete Thoracoscopic and Laparoscopic Esophagectomy for Esophageal Carcinoma. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(6): 686-690. doi: 10.7507/1007-4848.20130212 Copy

1.	陈万青，张思维，郑荣寿，等. 中国肿瘤登记地区2007年肿瘤发病和死亡分析. 中国肿瘤， 2011， 20 （3）：162-169.
2.	Takeuchi H， Kawakubo H， Kitagawa Y. Current status of minimally invasive esophagectomy for patients with esophageal cancer. Gen Thorac Cardiovasc Surg， 2013， 61 （9）：513-521.
3.	Zeng J， Liu JS. Quality of Life after three kinds of esophagectomy for Cancer. World J Gastroenterol， 2012， 18 （36）：5106-5113.
4.	Levy RM， Trivedi D， Luketich JD. Minimally invasive esophagectomy. Surg Clin North Am， 2012， 92 （5）：1265-1285.
5.	Schumer E， Perry K， Melvin WS. Minimally invasive esophagectomy for esophageal cancer：evolution and review. Surg Laparosc Endosc Percutan Tech， 2012， 22 （5）：383-386.
6.	Blom RL， Klinkenbijl JH， Hollmann MW， et al. Results of the introduction of a minimally invasive esophagectomy program in a tertiary referral center. J Thorac Dis， 2012， 4 （5）：467-473.
7.	Wu B， Xue L， Qiu M， et al. Video-assisted mediastinoscopic transhiatal esophagectomy combined with laparoscopy for esophageal cancer. J Cardiothorac Surg， 2010， 5：132.
8.	Zhu C， Jin K. Minimally invasive esophagectomy for esophageal cancer in the People's Republic of China：an overview. Onco Targets Ther， 2013， 6：119-124.
9.	Levy RM， Wizorek J， Shende M， et al. Laparoscopic and thoracoscopic esophagectomy. Adv Surg， 2010， 44：101-116.
10.	Yatabe T， Kitagawa H， Yamashita K， et al. Comparison of the perioperative outcome of esophagectomy by thoracoscopy in the prone position with that of thoracotomy in the lateral decubitus position. Surg Today， 2013， 43 （4）：386-391.
11.	Petri R， Zuccolo M， Brizzolari M， et al. Minimally invasive esophagectomy：thoracoscopic esophageal mobilization for esophageal cancer with the patient in prone position. Surg Endosc， 2012， 26 （4）：1102-1107.
12.	侯予龙，赵建强，郭伟，等. 俯卧位和左侧卧位胸腔镜食管切除术治疗食管癌疗效比较. 中华胃肠外科杂志， 2012， 15 （9）：950-953.
13.	Jarral OA， Purkayastha S， Athanasiou T， et al. Thoracoscopic esophagectomy in the prone position. Surg Endosc， 2012， 26 （8）：2095-2103.
14.	邵龙龙，相加庆. 食管癌腔镜手术现状. 中国癌症杂志， 2011， 21 （7）：528-532.
15.	Yamamoto S， Kawahara K， Maekawa T， et al. Minimally invasive esophagectomy for stage I and II esophageal cancer. Ann Thorac Surg， 2005， 80 （6）：2070-2075.
16.	Watanabe M， Baba Y， Nagai Y， et al. Minimally invasive esophag-ectomy for esophageal cancer：an updated review. Surg Today， 2013， 43 （3）：237-244.
17.	Luketich JD， Pennathur A， Awais O， et al. Outcomes after minimally invasive esophagectomy：review of over 1000 patients. Ann Surg， 2012， 256 （1）：95-103.
18.	Zhu ZJ， Zhao YF， Chen LQ， et al. Clinical application of layered anastomosis during esophagogastrostomy. World J Surg， 2008， 32 （4）：583-588.
19.	何荣琦，张万飞，庄建良，等. 纵隔引流管对食管癌术后吻合口瘘、心肺并发症的临床意义. 临床和实验医学杂志， 2012， 11 （23）：1866-1868.
20.	Yamamoto M， Weber JM， Karl RC， et al. Minimally invasivesurgery for esophageal cancer：review of the literature and institutionalexperience. Cancer Control， 2013， 20 （2）：130-137.

1. 　陈万青，张思维，郑荣寿，等. 中国肿瘤登记地区2007年肿瘤发病和死亡分析. 中国肿瘤， 2011， 20 （3）：162-169.
2. 　Takeuchi H， Kawakubo H， Kitagawa Y. Current status of minimally invasive esophagectomy for patients with esophageal cancer. Gen Thorac Cardiovasc Surg， 2013， 61 （9）：513-521.
3. 　Zeng J， Liu JS. Quality of Life after three kinds of esophagectomy for Cancer. World J Gastroenterol， 2012， 18 （36）：5106-5113.
4. 　Levy RM， Trivedi D， Luketich JD. Minimally invasive esophagectomy. Surg Clin North Am， 2012， 92 （5）：1265-1285.
5. 　Schumer E， Perry K， Melvin WS. Minimally invasive esophagectomy for esophageal cancer：evolution and review. Surg Laparosc Endosc Percutan Tech， 2012， 22 （5）：383-386.
6. 　Blom RL， Klinkenbijl JH， Hollmann MW， et al. Results of the introduction of a minimally invasive esophagectomy program in a tertiary referral center. J Thorac Dis， 2012， 4 （5）：467-473.
7. 　Wu B， Xue L， Qiu M， et al. Video-assisted mediastinoscopic transhiatal esophagectomy combined with laparoscopy for esophageal cancer. J Cardiothorac Surg， 2010， 5：132.
8. 　Zhu C， Jin K. Minimally invasive esophagectomy for esophageal cancer in the People's Republic of China：an overview. Onco Targets Ther， 2013， 6：119-124.
9. 　Levy RM， Wizorek J， Shende M， et al. Laparoscopic and thoracoscopic esophagectomy. Adv Surg， 2010， 44：101-116.
10. 　Yatabe T， Kitagawa H， Yamashita K， et al. Comparison of the perioperative outcome of esophagectomy by thoracoscopy in the prone position with that of thoracotomy in the lateral decubitus position. Surg Today， 2013， 43 （4）：386-391.
11. 　Petri R， Zuccolo M， Brizzolari M， et al. Minimally invasive esophagectomy：thoracoscopic esophageal mobilization for esophageal cancer with the patient in prone position. Surg Endosc， 2012， 26 （4）：1102-1107.
12. 　侯予龙，赵建强，郭伟，等. 俯卧位和左侧卧位胸腔镜食管切除术治疗食管癌疗效比较. 中华胃肠外科杂志， 2012， 15 （9）：950-953.
13. 　Jarral OA， Purkayastha S， Athanasiou T， et al. Thoracoscopic esophagectomy in the prone position. Surg Endosc， 2012， 26 （8）：2095-2103.
14. 　邵龙龙，相加庆. 食管癌腔镜手术现状. 中国癌症杂志， 2011， 21 （7）：528-532.
15. 　Yamamoto S， Kawahara K， Maekawa T， et al. Minimally invasive esophagectomy for stage I and II esophageal cancer. Ann Thorac Surg， 2005， 80 （6）：2070-2075.
16. 　Watanabe M， Baba Y， Nagai Y， et al. Minimally invasive esophag-ectomy for esophageal cancer：an updated review. Surg Today， 2013， 43 （3）：237-244.
17. 　Luketich JD， Pennathur A， Awais O， et al. Outcomes after minimally invasive esophagectomy：review of over 1000 patients. Ann Surg， 2012， 256 （1）：95-103.
18. 　Zhu ZJ， Zhao YF， Chen LQ， et al. Clinical application of layered anastomosis during esophagogastrostomy. World J Surg， 2008， 32 （4）：583-588.
19. 　何荣琦，张万飞，庄建良，等. 纵隔引流管对食管癌术后吻合口瘘、心肺并发症的临床意义. 临床和实验医学杂志， 2012， 11 （23）：1866-1868.
20. 　Yamamoto M， Weber JM， Karl RC， et al. Minimally invasivesurgery for esophageal cancer：review of the literature and institutionalexperience. Cancer Control， 2013， 20 （2）：130-137.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Outcomes of Combined Complete Thoracoscopic and Laparoscopic Esophagectomy for Esophageal Carcinoma

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