Clinical Analysis of 38 Patients with Esophageal Carcinoma Undergoing Toracoscopic and Laparoscopic Esophagectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YUXin ¹ ,  LIUYi ¹ , DUMing ² , WANGYi-lin ¹ , XIANGShu ¹

1. Department of Toracic Surgery, Central Hospital of Chongqing Tree Gorges, Chongqing 404000, P. R. China;
2. Department of Cardiothoracic Surgery, Te First Afliated Hospital of Chongqing Medical University, Chongqing 400042, P. R. China;

Corresponding author：

LIUYi, Email: liuyi_cq@yeah.net

Keywords：

Esophageal carcinoma; Thoracoscope; Laparoscope; Mimally invasive surgery

DOI：

10.7507/1007-4848.20150122

Video：

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Objective To summarize the clinical experience of thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma. Method We retrospectively analyzed the clinical data of 38 patients with esophageal carcinoma undergoing thoracoscopic and laparoscopic esophagectomy in Central Hospital of Chongqing Three Gorges between March 2011 and March 2013. There were 25 males and 13 females aged 64.25±7.68 years (ranged 45-79 years). The esophagus was freed and the lymph nodes were cleaned under the thoracoscope in the left lateral position. Then the stomach was freed under laparoscope and lifted up to anastomose with the esophagus through the passageway behind the sternal bone. Results All surgical process progressed successfully without intraoperative death or major hemorrhage. The total operating time ranged from 250 to 340 minutes. The intraoperative hemorrhage ranged from 80 to 350 ml. The number of lymph nodes cleaned ranged from 7 to 15 (10.24±2.04) and a total of 8 patients were found of tumor metastasis. Postoperative stage grading indicated 8 patients of T₁N₀M₀, 16 patients of T₂N₀M₀, 5 patients of T₂N₁M₀, 6 patients of T₃N₀M₀ and 3 patients of T₃N₁M₀. Postoperative complications included chylothorax in 1 patient, pulmonary infection in 4 patients, and cervical anastomotic leakage in 4 patients. All 38 patients were followed up for 3 to 12 (6.31±2.18) months, and 1 patient was lost. Two patients died from cervical anastomotic leakage resulting in chest infection. The other all achieved recoveries without metastatic or recurrence of tumor. Conclusion The intraoperative and postoperative complications of thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma are less frequently than traditional surgery, so it's worthy of promotion in large regional general hospitals.

Citation： YUXin, LIUYi, DUMing, WANGYi-lin, XIANGShu. Clinical Analysis of 38 Patients with Esophageal Carcinoma Undergoing Toracoscopic and Laparoscopic Esophagectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(5): 467-470. doi: 10.7507/1007-4848.20150122 Copy

1.	赫捷, 邵康.中国食管癌流行病学现状、诊疗现状及未来对策.中国癌症杂志, 2011, 21(7):501-504.
2.	Kawakubo H, Takeuchi H, Kitagawa Y. Current status and future perspectives on minimally invasive esophagectomy. Korean J Torac Cardiovasc Surg, 2013, 46(4):241-248.
3.	Luketich JD, Alvelo-Rivera M, Buenaventura PO, et al. Minimally invasive esophagectomy:outcomes in 222 patients. Ann Surg, 2003, 238(4):486-494, discussion 494-485.
4.	姚晓军, 张洪伟, 郑兴龙, 等.全胸腹腔镜联合手术治疗食管癌的疗效分析.中国胸心血管外科临床杂志, 2013, 20(6):686-690.
5.	Baccari P, Castoldi R, Bisagni P, et al. Minimally invasive esophagectomy for adenocarcinoma of the lower esophagus and the gastroesophageal junction. Suppl Tumori, 2005, 4(3):S129.
6.	Palanivelu C, Prakash A, Senthilkumar R, et al. Minimally invasive esophagectomy:thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position——experience of 130 patients. J Am Coll Surg, 2006, 203(1):7-16.
7.	杨楠兰.电视胸腹腔镜联合与传统开胸下食管癌切除术后患者生活质量的比较.齐齐哈尔医学院学报, 2010, 31(4):521-522.
8.	赵文栋.胸腹腔镜联合应用对食管癌患者CRP和生活质量的影响.中国实用医药, 2013, 8(14):35-36.
9.	熊宏超, 吴楠, 陈晋峰, 等.腹胸两切口加两野淋巴结清扫治疗胃食管交界部癌的临床研究.中华医学杂志, 2007, 87(21):1478-1481.
10.	Akiyama H, Tsurumaru M, Udagawa H, et al. Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg, 1994, 220(3):364-372.
11.	Fujita H, Kakegawa T, Yamana H, et al. Mortality and morbidity rates, postoperative course, quality of life, and prognosis after extended radical lymphadenectomy for esophageal cancer. Comparison of three-field lymphadenectomy with two-field lymphadenectomy. Ann Surg, 1995, 222(5):654-662.
12.	沈亮, 王永旺, 仲崇俊.胸腹腔镜联合食管癌切除与传统手术的对比分析.中华腔镜外科杂志(电子版), 2013, 6(2):122-125.
13.	Cadiere GB, Torres R, Dapri G, et al. Toracoscopic and laparoscopic oesophagectomy improves the quality of extended lymphadenectomy. Surg Endosc, 2006, 20(8):1308-1309.
14.	陈保富, 朱成楚, 马德华, 等.胸、腹腔镜联合手术治疗食管癌.中国微创外科杂志, 2009, 9(8):707-708, 711.
15.	Bonavina L, Laface L, Abate E, et al. Comparison of ventilation and cardiovascular parameters between prone thoracoscopic and Ivor Lewis esophagectomy. Updates Surg, 2012, 64(2):81-85.
16.	Zou YB, Yan H, Liu XH, et al. Lateral position could provide more excellent hemodynamic parameters during video-assisted thoracoscopic esophagectomy for cancer. Surg Endosc, 2013, 27(10):3720-3725.
17.	Fabian T, Martin J, Katigbak M, et al. Thoracoscopic esophageal mobilization during minimally invasive esophagectomy:a head-tohead comparison of prone versus decubitus positions. Surg Endosc, 2008, 22(11):2485-2491.
18.	谭黎杰, 王群, 冯明祥, 等.一种新的食管切除法——俯卧位胸腔镜食管切除术(附8例报告).中国临床医学, 2009, 16(5):720-721.
19.	Zhu ZJ, Zhao YF, Chen LQ, et al. Clinical application of layered anastomosis during esophagogastrostomy. World J Surg, 2008, 32(4):583-588.
20.	方文涛, 陈文虎, 范利民, 等.食管癌切除术后不同重建途径吻合口瘘的原闻及预防.中华胃肠外科杂志, 2005, 8(3):217-219.
21.	杜铭, 陈焕文, 吴庆琛, 等.胸腔镜联合腹腔镜食管癌切除术治疗40例食管癌的临床分析.第三军医大学学报, 2010, 32(7):722-724.

1. 赫捷, 邵康.中国食管癌流行病学现状、诊疗现状及未来对策.中国癌症杂志, 2011, 21(7):501-504.
2. Kawakubo H, Takeuchi H, Kitagawa Y. Current status and future perspectives on minimally invasive esophagectomy. Korean J Torac Cardiovasc Surg, 2013, 46(4):241-248.
3. Luketich JD, Alvelo-Rivera M, Buenaventura PO, et al. Minimally invasive esophagectomy:outcomes in 222 patients. Ann Surg, 2003, 238(4):486-494, discussion 494-485.
4. 姚晓军, 张洪伟, 郑兴龙, 等.全胸腹腔镜联合手术治疗食管癌的疗效分析.中国胸心血管外科临床杂志, 2013, 20(6):686-690.
5. Baccari P, Castoldi R, Bisagni P, et al. Minimally invasive esophagectomy for adenocarcinoma of the lower esophagus and the gastroesophageal junction. Suppl Tumori, 2005, 4(3):S129.
6. Palanivelu C, Prakash A, Senthilkumar R, et al. Minimally invasive esophagectomy:thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position——experience of 130 patients. J Am Coll Surg, 2006, 203(1):7-16.
7. 杨楠兰.电视胸腹腔镜联合与传统开胸下食管癌切除术后患者生活质量的比较.齐齐哈尔医学院学报, 2010, 31(4):521-522.
8. 赵文栋.胸腹腔镜联合应用对食管癌患者CRP和生活质量的影响.中国实用医药, 2013, 8(14):35-36.
9. 熊宏超, 吴楠, 陈晋峰, 等.腹胸两切口加两野淋巴结清扫治疗胃食管交界部癌的临床研究.中华医学杂志, 2007, 87(21):1478-1481.
10. Akiyama H, Tsurumaru M, Udagawa H, et al. Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg, 1994, 220(3):364-372.
11. Fujita H, Kakegawa T, Yamana H, et al. Mortality and morbidity rates, postoperative course, quality of life, and prognosis after extended radical lymphadenectomy for esophageal cancer. Comparison of three-field lymphadenectomy with two-field lymphadenectomy. Ann Surg, 1995, 222(5):654-662.
12. 沈亮, 王永旺, 仲崇俊.胸腹腔镜联合食管癌切除与传统手术的对比分析.中华腔镜外科杂志(电子版), 2013, 6(2):122-125.
13. Cadiere GB, Torres R, Dapri G, et al. Toracoscopic and laparoscopic oesophagectomy improves the quality of extended lymphadenectomy. Surg Endosc, 2006, 20(8):1308-1309.
14. 陈保富, 朱成楚, 马德华, 等.胸、腹腔镜联合手术治疗食管癌.中国微创外科杂志, 2009, 9(8):707-708, 711.
15. Bonavina L, Laface L, Abate E, et al. Comparison of ventilation and cardiovascular parameters between prone thoracoscopic and Ivor Lewis esophagectomy. Updates Surg, 2012, 64(2):81-85.
16. Zou YB, Yan H, Liu XH, et al. Lateral position could provide more excellent hemodynamic parameters during video-assisted thoracoscopic esophagectomy for cancer. Surg Endosc, 2013, 27(10):3720-3725.
17. Fabian T, Martin J, Katigbak M, et al. Thoracoscopic esophageal mobilization during minimally invasive esophagectomy:a head-tohead comparison of prone versus decubitus positions. Surg Endosc, 2008, 22(11):2485-2491.
18. 谭黎杰, 王群, 冯明祥, 等.一种新的食管切除法——俯卧位胸腔镜食管切除术(附8例报告).中国临床医学, 2009, 16(5):720-721.
19. Zhu ZJ, Zhao YF, Chen LQ, et al. Clinical application of layered anastomosis during esophagogastrostomy. World J Surg, 2008, 32(4):583-588.
20. 方文涛, 陈文虎, 范利民, 等.食管癌切除术后不同重建途径吻合口瘘的原闻及预防.中华胃肠外科杂志, 2005, 8(3):217-219.
21. 杜铭, 陈焕文, 吴庆琛, 等.胸腔镜联合腹腔镜食管癌切除术治疗40例食管癌的临床分析.第三军医大学学报, 2010, 32(7):722-724.

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Clinical Analysis of 38 Patients with Esophageal Carcinoma Undergoing Toracoscopic and Laparoscopic Esophagectomy

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