The modified minimally invasive esophagectomy using the concept of "single-direction" thoracoscopic technique_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

NIU Lingli , GU Yimin , ZHU Yunke , ZHANG Hanlu , CHEN Longqi ,  WANG Wenping

Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

WANG Wenping, Email: drwangwp@163.com

Keywords：

Esophageal carcinoma; minimally invasive esophagectomy; "single-direction" thoracoscopic surgery

DOI：

10.7507/1007-4848.202103081

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To explore the safety and feasibility of the modified and improved thoracoscopic surgery for esophageal cancer using the concept of "single-direction" thoracoscopic technique.Methods The clinical data of 65 patients undergoing this modified minimally invasive esophagectomy based on "single-direction" thoracoscopic system between June 2018 and April 2019 were retrospectively analyzed, including 54 males and 11 females aged 62.5±7.8 years.Results The thoracoscopic operation time was 133.4±28.6 min, and intraoperative blood loss was 61.9±29.2 mL. No intraoperative blood transfusion was needed. One patient was transferred to open thoracotomy (due to severe pleural adhesion atresia). Major complications included anastomotic leak, pneumonia, chylothorax, incisional infection, recurrent laryngeal nerve paralysis and gastric emptying disorders, which were recovered by conservative treatment. No postoperative death occurred. The median number of lymph nodes and lymph node station harvested was 19 and 10, respectively. The median postoperative hospital stay was 10 days. The volume of chest drainage was 1 117.3±543.4 mL.Conclusion The minimally invasive operation mode of esophageal cancer based on "single-direction" thoracoscopic system is safe and feasible, and has good field vision and smooth and simplified procedure.

Citation： NIU Lingli, GU Yimin, ZHU Yunke, ZHANG Hanlu, CHEN Longqi, WANG Wenping. The modified minimally invasive esophagectomy using the concept of "single-direction" thoracoscopic technique. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(8): 972-978. doi: 10.7507/1007-4848.202103081 Copy

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2.	Luketich JD, Alvelo-Rivera M, Buenaventura PO, et al. Minimally invasive esophagectomy: Outcomes in 222 patients. Ann Surg, 2003, 238(4): 486-494.
3.	Jiang T, Lin M, Zhan C, et al. High-pressure artificial pneumothorax promotes invasion and metastasis of esophageal cancer cells. Interact Cardiovasc Thorac Surg, 2019: ivz085.
4.	Liu L, Che G, Pu Q, et al. A new concept of endoscopic lung cancer resection: Single-direction thoracoscopic lobectomy. Surg Oncol, 2010, 19(2): e71-e77.
5.	Mei J, Pu Q, Liao H, et al. A novel method for troubleshooting vascular injury during anatomic thoracoscopic pulmonary resection without conversion to thoracotomy. Surg Endosc, 2013, 27(2): 530-537.
6.	Liu C, Pu Q, Guo C, et al. Non-grasping en bloc mediastinal lymph node dissection for video-assisted thoracoscopic lung cancer surgery. BMC Surg, 2015, 15: 38.
7.	刘伦旭, 刘成武, 杨俊杰. 胸腔镜肺叶切除术: 技术优化与应用拓展. 四川大学学报(医学版). 2013, 44(1): 104-108.
8.	Melamed A, Margul DJ, Chen L, et al. Survival after minimally invasive radical hysterectomy for early-stage cervical cancer. N Engl J Med, 2018, 379(20): 1905-1914.
9.	Ramirez PT, Frumovitz M, Pareja R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med, 2018, 379(20): 1895-1904.
10.	Ji X, Cai J, Chen Y, et al. Lymphatic spreading and lymphadenectomy for esophageal carcinoma. World J Gastrointest Surg, 2016, 8(1): 90-94.
11.	Kuge K, Murakami G, Mizobuchi S, et al. Submucosal territory of the direct lymphatic drainage system to the thoracic duct in the human esophagus. J Thorac Cardiovasc Surg, 2003, 125(6): 1343-1349.
12.	Leers JM, DeMeester SR, Oezcelik A, et al. The prevalence of lymph node metastases in patients with T1 esophageal adenocarcinoma a retrospective review of esophagectomy specimens. Ann Surg, 2011, 253(2): 271-278.
13.	Schoppmann SF, Jesch B, Zacherl J, et al. Lymphangiogenesis and lymphovascular invasion diminishes prognosis in esophageal cancer. Surgery, 2013, 153(4): 526-534.
14.	Cen P, Hofstetter WL, Correa AM, et al. Lymphovascular invasion as a tool to further subclassify T1b esophageal adenocarcinoma. Cancer, 2008, 112(5): 1020-1027.
15.	Yang YS, Wang WP, Chen LQ. The effect of interaction between lymphovascular invasion and lymph node metastasis. Surgery, 2017, 161(5): 1466-1467.
16.	Gu YM, Yang YS, Hu WP, et al. Prognostic value of lymphovascular invasion in patients with esophageal squamous cell carcinoma. Ann Transl Med, 2019, 7(12): 256.

1. Luketich JD, Schauer PR, Christie NA, et al. Minimally invasive esophagectomy. Ann Thorac Surg, 2000, 70(3): 906-911.
2. Luketich JD, Alvelo-Rivera M, Buenaventura PO, et al. Minimally invasive esophagectomy: Outcomes in 222 patients. Ann Surg, 2003, 238(4): 486-494.
3. Jiang T, Lin M, Zhan C, et al. High-pressure artificial pneumothorax promotes invasion and metastasis of esophageal cancer cells. Interact Cardiovasc Thorac Surg, 2019: ivz085.
4. Liu L, Che G, Pu Q, et al. A new concept of endoscopic lung cancer resection: Single-direction thoracoscopic lobectomy. Surg Oncol, 2010, 19(2): e71-e77.
5. Mei J, Pu Q, Liao H, et al. A novel method for troubleshooting vascular injury during anatomic thoracoscopic pulmonary resection without conversion to thoracotomy. Surg Endosc, 2013, 27(2): 530-537.
6. Liu C, Pu Q, Guo C, et al. Non-grasping en bloc mediastinal lymph node dissection for video-assisted thoracoscopic lung cancer surgery. BMC Surg, 2015, 15: 38.
7. 刘伦旭, 刘成武, 杨俊杰. 胸腔镜肺叶切除术: 技术优化与应用拓展. 四川大学学报(医学版). 2013, 44(1): 104-108.
8. Melamed A, Margul DJ, Chen L, et al. Survival after minimally invasive radical hysterectomy for early-stage cervical cancer. N Engl J Med, 2018, 379(20): 1905-1914.
9. Ramirez PT, Frumovitz M, Pareja R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med, 2018, 379(20): 1895-1904.
10. Ji X, Cai J, Chen Y, et al. Lymphatic spreading and lymphadenectomy for esophageal carcinoma. World J Gastrointest Surg, 2016, 8(1): 90-94.
11. Kuge K, Murakami G, Mizobuchi S, et al. Submucosal territory of the direct lymphatic drainage system to the thoracic duct in the human esophagus. J Thorac Cardiovasc Surg, 2003, 125(6): 1343-1349.
12. Leers JM, DeMeester SR, Oezcelik A, et al. The prevalence of lymph node metastases in patients with T1 esophageal adenocarcinoma a retrospective review of esophagectomy specimens. Ann Surg, 2011, 253(2): 271-278.
13. Schoppmann SF, Jesch B, Zacherl J, et al. Lymphangiogenesis and lymphovascular invasion diminishes prognosis in esophageal cancer. Surgery, 2013, 153(4): 526-534.
14. Cen P, Hofstetter WL, Correa AM, et al. Lymphovascular invasion as a tool to further subclassify T1b esophageal adenocarcinoma. Cancer, 2008, 112(5): 1020-1027.
15. Yang YS, Wang WP, Chen LQ. The effect of interaction between lymphovascular invasion and lymph node metastasis. Surgery, 2017, 161(5): 1466-1467.
16. Gu YM, Yang YS, Hu WP, et al. Prognostic value of lymphovascular invasion in patients with esophageal squamous cell carcinoma. Ann Transl Med, 2019, 7(12): 256.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The modified minimally invasive esophagectomy using the concept of "single-direction" thoracoscopic technique

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