Objective To explore the causes of conversion to thoracotomy in patients with minimally invasive esophagectomy (MIE) in a surgical team, and to obtain a deeper understanding of the timing of conversion in MIE. Methods The clinical data of patients who underwent MIE between September 9, 2011 and February 12, 2022 by a single surgical team in the Department of Thoracic Surgery of the Fourth Hospital of Hebei Medical University were retrospectively analyzed. The main influencing factors and perioperative mortality of patients who converted to thoracotomy in this group were analyzed. Results In the cohort of 791 consecutive patients with MIE, there were 520 males and 271 females, including 29 patients of multiple esophageal cancer, 156 patients of upper thoracic cancer, 524 patients of middle thoracic cancer, and 82 patients of lower thoracic cancer. And 46 patients were converted to thoracotomy for different causes. The main causes for thoracotomy were advanced stage tumor (26 patients), anesthesia-related factors (5 patients), extensive thoracic adhesions (6 patients), and accidental injury of important structures (8 patients). There was a statistical difference in the distribution of tumor locations between patients who converted to thoracotomy and the MIE patients (P<0.05). The proportion of multiple and upper thoracic cancer in patients who converted to thoracotomy was higher than that in the MIE patients, while the proportion of lower thoracic cancer was lower than that in the MIE patients. The perioperative mortality of the thoracotomy patients was not significantly different from that of the MIE patients (P=1.000). Conclusion In MIE, advanced-stage tumor, anesthesia-related factors, extensive thoracic adhesions, and accidental injury of important structures are the main causes of conversion to thoracotomy. The rate varies at different tumor locations. Intraoperative conversion to thoracotomy does not affect the perioperative mortality of MIE.
ObjectiveTo explore the effect of mediastinal drainage tube placed after the esophageal cancer resection with intrathoracic anastomosis on postoperative complications such as anastomotic fistula. MethodsLiterature on the application of mediastinal drainage tubes in esophageal cancer surgery published in databases such as PubMed, EMbase, CNKI, China Biomedical Literature Database, VIP, and Wanfang were searched using English or Chinese, from the establishment of the databases to December 31, 2023. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included retrospective studies, the Cochrane Handbook bias risk tool was used to assess the bias risk of randomized controlled trials (RCT), and Review Manager 5.4 software was used for meta-analysis. ResultsA total of 19 retrospective studies and 8 RCT involving 6320 patients were included, with 3257 patients in the observation group (mediastinal drainage tube+closed thoracic drainage tube) and 3063 patients in the control group (closed thoracic drainage tube or single mediastinal drainage tube). The NOS score of the included literature was≥6 points, and one RCT had a low risk of bias and the other RCT had a moderate risk of bias . Meta-analysis results showed that compared with the control group, the observation group had fewer postoperative lung complications [OR=0.44, 95%CI (0.36, 0.53), P<0.001], fewer postoperative cardiac complications [OR=0.40, 95%CI (0.33, 0.49), P<0.001], earlier average diagnosis time of anastomotic fistula [MD=−3.33, 95%CI (−3.95, −2.71), P<0.001], lower inflammation indicators [body temperature: MD=−1.15, 95%CI (−1.36, −0.93), P<0.001; white cell count: MD=−5.62, 95%CI (−7.29, −3.96), P<0.001], and shorter postoperative hospital stay [MD=−15.13, 95%CI (−18.69, −11.56), P<0.001]. However, there was no statistically significant difference in the incidence of postoperative anastomotic fistula between the two groups [OR=0.85, 95%CI (0.70, 1.05), P=0.13]. ConclusionPlacing a mediastinal drainage tube cannot reduce the incidence of anastomotic fistula, but it can effectively reduce the incidence of postoperative respiratory and circulatory system complications in patients and improve patients’ prognosis. It can early detect teh anastomotic fistula and fully drain digestive fluid to promote rapid healing of the fistula, alleviate the infection symptoms of postoperative anastomotic fistula, and shorten the hospital stay.