Abstract： Objective To investigate the indications， surgical techniques and postoperative complication management of transhiatal esophagectomy without thoracotomy for patients with esophageal cancer. Methods We retrospectively analyzed the clinical records of 105 patients with esophageal cancer who underwent transhiatal esophagectomy without thoracotomy in the First Affiliated Hospital of Nanjing Medical University between July 2002 and July 2010， including 28 patients who received video-assisted mediastinoscopy. There were 59 male patients and 46 female patients with their average age of 63 （48-81） years. There were 51 patients with upper thoracic esophageal cancer， 18 patients with middle thoracic esophageal cancer and 36 patients with lower thoracic esophageal cancer. Surgical outcomes and safety were evaluated. Results Mean operation time was 153 （140-210） minutes， mean intraoperative blood loss was 150 （100 to 250） ml， and mean hospital stay was 15 （10-35） days. There was no in-hospital death or residual tumor cells in esophagus stumps. Twenty-seven patients had postoperative complications， including 3 patients with anastomotic leakage at neck， 4 patients with recurrent laryngeal nerve injury， 5 patients with pleural effusion， 2 patients with pneumothorax， 3 patients with pneumonia， 3 patients with arrhythmia， 1 patient with chylothorax， 2 patients with incision infection， 2 patients with delayed gastric emptying， and 2 patients with anastomotic stenosis， who were all cured after treatment. Ninety-seven patients were followed up from 16 months to 5 years， and 8 patients were lost during follow-up. During follow-up， there were 94 patients who had lived for 1 year， 67 patients who had lived for 3 years， and 34 patients who had lived for 5 years postoperatively， and some patients needed further follow-up. Conclusion Transhiatal esophagectomy without thoracotomy is a minimally traumatic procedure and can provide fast postoperative recovery. It is especially suitable for patients with stageⅡor earlier esophageal cancer who can’t tolerate or aren’t suitable for transthoracic esophagectomy.
Citation：
Department of Cardiothoracic Surgery,First Affiliated Hospital of Nanjing Medical University,Nanjing,P. R. China. Transhiatal Esophagectomy without Thoracotomy in 105 Patients with Esophageal Cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(1): 59-62. doi:
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曹秀峰， 肖建， 王山， 等. 食管内翻拔脱术治疗食管癌71例体会. 临床肿瘤学杂志， 2007， 12 （6）：441-444.
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毛友生， 赫捷， 程贵余. 我国食管癌外科治疗的现状与未来对策. 中华肿瘤杂志， 2010， 32 （6）：401-404.
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郭伟， 王如文， 蒋耀光. 食管切除术围手术期处理进展. 中国胸心血管外科临床杂志， 2010， 17 （2）：145-149.
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D'journo XB， Michelet P， Avaro JP， et al. Respiratory complications after oesophagectomy for cancer. Rev Mal Respir， 2008， 25 （6）：683-694.
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Barreto JC， Posner MC. Transhiatal versus transthoracic esophagectomy for esophageal cancer. World J Gastroenterol， 2010， 16 （30）：3804-3810.
|
| 6. |
李轶川， 伍伫， 蒋良双， 等. 食管内翻拔脱术治疗食管癌46例. 中国胸心血管外科临床杂志， 2007， 14 （6）：480-480.
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Venissac N， Pop D， Mouroux J. Video-assisted mediastinoscopy as a therapeutic tool. Surg Endosc， 2009， 23 （11）：2466-2472.
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Pop D， Venissac N， Mouroux J. Video-assisted mediastinoscopy improved radical resection for cancer in transhiatal esophagectomy. J Thorac Cardiovasc Surg， 2007， 133 （1）：267-268.
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Mimatsu K， Oida T， Kawasaki A， et al. Mediastinoscopy-assisted esophagectomy is useful technique for poor surgical-risk patients with thoracic esophageal cancer. Surg Laparosc Endosc Percutan Tech， 2009， 19 （1）：e17-e20.
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谭黎杰， 徐正浪， 仇德惠， 等. 电视纵隔镜辅助食管切除术安全性探讨. 中国微创外科杂志， 2003， 3 （5）：406-407.
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王中林， 张蕾， 陆一民， 等. 电视纵隔镜手术治疗早期食管癌89例报告. 中国微创外科杂志， 2010， 10 （3）：262-263.
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王志恒， 林若柏. 电视纵隔镜检查的临床应用. 国际外科学杂志， 2008， 35 （3）：189-191.
|
| 13. |
邵丰， 苏宜江， 许栋生， 等. 电视纵隔镜手术诊治胸部疾病36例. 中国胸心血管外科临床杂志， 2009， 16 （1）：76-78.
|
| 14. |
吴彬， 徐志飞， 仇明， 等. 纵隔镜下食管癌切除. 中华消化外科杂志， 2007， 6 （6）：407-409.
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Turkyilmaz A， Eroglu A， Aydin Y， et al. The management of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma. Dis Esophagus， 2009， 22 （2）：119-126.
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Delgado Gomis F， Gómez Abril SA， Martínez Abad M， et al. Assisted laparoscopic transhiatal esophagectomy for the treatment of esophageal cancer. Clin Transl Oncol， 2006， 8 （3）：185-192.
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Tabatabai A， Hashemi M， Mohajeri G， et al. Incidence and risk factors predisposing anastomotic leak after transhiatal esophagectomy. Ann Thorac Med， 2009， 4 （4）：197-200.
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Colvin H， Dunning J， Khan OA. Transthoracic versus transhiatal esophagectomy for distal esophageal cancer：which is superior ? Inte ract Cardiovasc Thorac Surg， 2011， 12 （2）：265-269.
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Homesh NA， Alsabahi AA， Al-Agmar MH， et al. Transhiatal versus transthoracic resection for oesophageal carcinoma in Yemen. Singapore Med J， 2006， 47 （1）：54-59.
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Boshier PR， Anderson O， Hanna GB. Transthoracic versus transhiatal esophagectomy for the treatment of esophagogastric cancer：a meta-analysis. Ann Surg， 2011， 254 （6）：894-906.
|
- 1. 曹秀峰， 肖建， 王山， 等. 食管内翻拔脱术治疗食管癌71例体会. 临床肿瘤学杂志， 2007， 12 （6）：441-444.
- 2. 毛友生， 赫捷， 程贵余. 我国食管癌外科治疗的现状与未来对策. 中华肿瘤杂志， 2010， 32 （6）：401-404.
- 3. 郭伟， 王如文， 蒋耀光. 食管切除术围手术期处理进展. 中国胸心血管外科临床杂志， 2010， 17 （2）：145-149.
- 4. D'journo XB， Michelet P， Avaro JP， et al. Respiratory complications after oesophagectomy for cancer. Rev Mal Respir， 2008， 25 （6）：683-694.
- 5. Barreto JC， Posner MC. Transhiatal versus transthoracic esophagectomy for esophageal cancer. World J Gastroenterol， 2010， 16 （30）：3804-3810.
- 6. 李轶川， 伍伫， 蒋良双， 等. 食管内翻拔脱术治疗食管癌46例. 中国胸心血管外科临床杂志， 2007， 14 （6）：480-480.
- 7. Venissac N， Pop D， Mouroux J. Video-assisted mediastinoscopy as a therapeutic tool. Surg Endosc， 2009， 23 （11）：2466-2472.
- 8. Pop D， Venissac N， Mouroux J. Video-assisted mediastinoscopy improved radical resection for cancer in transhiatal esophagectomy. J Thorac Cardiovasc Surg， 2007， 133 （1）：267-268.
- 9. Mimatsu K， Oida T， Kawasaki A， et al. Mediastinoscopy-assisted esophagectomy is useful technique for poor surgical-risk patients with thoracic esophageal cancer. Surg Laparosc Endosc Percutan Tech， 2009， 19 （1）：e17-e20.
- 10. 谭黎杰， 徐正浪， 仇德惠， 等. 电视纵隔镜辅助食管切除术安全性探讨. 中国微创外科杂志， 2003， 3 （5）：406-407.
- 11. 王中林， 张蕾， 陆一民， 等. 电视纵隔镜手术治疗早期食管癌89例报告. 中国微创外科杂志， 2010， 10 （3）：262-263.
- 12. 王志恒， 林若柏. 电视纵隔镜检查的临床应用. 国际外科学杂志， 2008， 35 （3）：189-191.
- 13. 邵丰， 苏宜江， 许栋生， 等. 电视纵隔镜手术诊治胸部疾病36例. 中国胸心血管外科临床杂志， 2009， 16 （1）：76-78.
- 14. 吴彬， 徐志飞， 仇明， 等. 纵隔镜下食管癌切除. 中华消化外科杂志， 2007， 6 （6）：407-409.
- 15. Turkyilmaz A， Eroglu A， Aydin Y， et al. The management of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma. Dis Esophagus， 2009， 22 （2）：119-126.
- 16. Delgado Gomis F， Gómez Abril SA， Martínez Abad M， et al. Assisted laparoscopic transhiatal esophagectomy for the treatment of esophageal cancer. Clin Transl Oncol， 2006， 8 （3）：185-192.
- 17. Tabatabai A， Hashemi M， Mohajeri G， et al. Incidence and risk factors predisposing anastomotic leak after transhiatal esophagectomy. Ann Thorac Med， 2009， 4 （4）：197-200.
- 18. Colvin H， Dunning J， Khan OA. Transthoracic versus transhiatal esophagectomy for distal esophageal cancer：which is superior ? Inte ract Cardiovasc Thorac Surg， 2011， 12 （2）：265-269.
- 19. Homesh NA， Alsabahi AA， Al-Agmar MH， et al. Transhiatal versus transthoracic resection for oesophageal carcinoma in Yemen. Singapore Med J， 2006， 47 （1）：54-59.
- 20. Boshier PR， Anderson O， Hanna GB. Transthoracic versus transhiatal esophagectomy for the treatment of esophagogastric cancer：a meta-analysis. Ann Surg， 2011， 254 （6）：894-906.
