Objective To explore the safety of minimally invasive esophagectomy (MIE) with three-field lymphadenectomy (3-FL) for esophageal squamous cell carcinoma (ESCC) by comparing the short-term outcomes between the 3-FL and the two-field lymphadenectomy (2-FL) in MIE. Methods The clinical data of patients with ESCC who underwent minimally invasive McKeown esophagectomy in our hospital from July 2015 to March 2022 were collected retrospectively. Patients were divided into a 3-FL group and a 2-FL group according to lymph node dissection method. And the clinical outcomes and postoperative complications were compared between the two groups. Results A total of 257 patients with ESCC were included in this study. There were 211 males and 46 females with an average age of 62.2±8.1 years. There were 109 patients in the 3-FL group and 148 patients in the 2-FL group. The operation time of the 3-FL group was about 20 minutes longer than that of the 2-FL group (P<0.001). There was no statistical difference between the two groups in the intraoperatve blood loss (P=0.376). More lymph nodes (P<0.001) and also more positive lymph nodes (P=0.003) were obtained in the 3-FL group than in the 2-FL group, and there was a statistical difference in the pathological N stage between the two groups (P<0.001). But there was no statistical difference in the incidence of anastomotic leak (P=0.667), chyle leak (P=0.421), recurrent laryngeal nerve injury (P=0.081), pulmonary complications (P=0.601), pneumonia (P=0.061), cardiac complications (P=0.383), overall complications (P=0.147) or Clavien-Dindo grading (P=0.152) between the two groups. Conclusion MIE 3-FL can improve the efficiency of lymph node dissection and the accuracy of tumor lymph node staging, but it does not increase the postoperative complications, which is worthy of clinical application.
Objective To evaluate the safety and efficacy of neoadjuvant therapy followed by minimally invasive esophagectomy (MIE) for locally advanced esophageal cancer. Methods We retrospectively analyzed clinical data of 56 consecutive patients with locally advanced esophageal cancer treated by neoadjuvant therapy followed by surgery in our hospital between January 2015 and December 2016. There were 51 males and 5 females. The patients were divided into 2 groups. Neoadjuvant therapy followed by open surgery esophagectomy group was as an OE group with 25 patients aged 61 (50-73) years. And neoadjuvant therapy followed by MIE was as a MIE group with 31 patients aged 60 (55-79) years. Results The pathologic complete response (pCR) rate of 28 patients with neoadjuvant concurrent chemoradiotherapy was significantly higher than that of 28 patients with neoadjuvant chemotherapy (21.4% vs. 10.7%, P<0.05). The operation time, intraoperative blood loss, R2 rate and the number of lymph nodes dissection in the MIE group were obviously better than those of the OE group with statistical differences (P<0.05). However, there was no significant difference in the number of resected lymph nodes along the bilateral recurrent laryngeal nerves and lymph node metastasis rate (P>0.05) between the two groups. The incidence of postoperative respiratory complications in the MIE group was lower than that of the OE group (P=0.041). There was no significant difference between the two groups in the incidence of other complications, re-operation, re-entry to ICU, median length of stay or perioperative deaths (P>0.05). There was only one patient with neoadjuvant concurrent chemoradiotherapy in the OE group died due to gastric fluid asphyxia caused by trachea-esophageal fistula. Conclusion Neoadjuvant therapy followed by MIE for locally advanced esophageal cancer is safe and feasible. The oncological outcomes seem comparable regardless of OE.
ObjectiveTo explore the safety and feasibility of the modified and improved thoracoscopic surgery for esophageal cancer using the concept of "single-direction" thoracoscopic technique.MethodsThe 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.ResultsThe 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.ConclusionThe 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.
Nowadays, thoracoscopic laparoscopic esophagectomy (TLE) has been widely used in the treatment of esophageal cancer. In recent years, robot assisted minimally invasive esophagectomy (RAMIE) has been developing vigorously. According to the research progress and practical experience in the world, RAMIE has the same safety and effectiveness as TLE. In this paper, several aspects on this novel operation were demonstrated, including the safety evaluation, lymph node dissection, prognosis of RAMIE, comparison of RAMIE and TLE, and the role of RAMIE in multidisciplinary treatment of esophageal cancer, in order to promote the rational application of RAMIE in esophagectomy.
Objective To compare the short-term efficacy of Ivor-Lewis via hand-sewn purse-string approach and purse-string forceps approach in minimally invasive esophagectomy for middle and lower esophageal cancer, and to discuss the safety and feasibility of hand-sewn purse-string anastomosis technique for minimally invasive Ivor-Lewis esophagectomy (MIILE). Methods The clinical data of 151 patients undergoing thoracoscopic and laparoscopic esophageal cancer surgery from January 2014 to January 2017 in our hospital were retrospectively analyzed. According to the different methods of purse string making, the patients were divided into a purse-string forceps group including 49 males and 16 females with a mean age of 67.98±7.07 years ranging from 51 to 80 years treated with forceps to make purse-string and a handcraft group including 61 males and 25 females with a mean age of 67.76±8.18 years ranging from 52 to 83 years using hand-sewn way. The perioperative data of two two groups were compared. Results The purse-string making time and postoperative total volume of chest drainage were less in the handcraft group than those in the purse-string forceps group (P<0.05). There was no significant difference between the two groups in hemorrhage during operation, the operation duration or postoperative hospital stay (P>0.05). There was also no statistical difference between the two groups in the rate of anastomotic or gastric tube fistula, anastomotic stenosis, pulmonary infection or incision infection (P>0.05). Conclusion In minimally invasive esophagectomy for middle-lower section, MIILE by hand-sewn purse-string is as safe as purse-string forceps, with no more complications, needing no professional equipments, and easy to learn, master and promote.
Objective To evaluate the security and outcomes of thoracolaparoscopic esophagectomy (TLE) versus open approach (OA) for thoracic esophageal squamous cell carcinoma. Methods From June 2014 to June 2015, 125 patients with thoracic esophageal squamous cell carcinoma underwent esophagectomy through McKeown approach, including TLE (a TLE group, 107 patients, 77 males and 30 females) and OA (an OA group, 18 patients, 13 males and 5 females). The data of operation and postoperative complications of the two groups were analyzed retrospectively. Results There was no statistical difference in the duration of operation and ICU stay and resected lymph nodes around laryngeal recurrent nerve between the TLE group and the OA group (333.58±72.84 min vs. 369.17±91.24 min, P=0.067; 2.84±1.44 d vs. 6.44±13.46 d, P=0.272; 4.71±3.87 vs. 3.89±3.97, P=0.408) . There was a statistical difference in blood loss, total resected lymph nodes and resected lymph nodes groups between TLE group and OA group (222.62±139.77 ml vs. 427.78±276.65, P=0.006; 19.62±9.61 vs. 14.61±8.07, P=0.038; 3.70±0.99 vs. 3.11±1.13, P=0.024). The rate of postoperative complications was 32.7% in the TLE group and 38.9% in the OA group (P=0.608). There was a statistical difference (P=0.011) in incidence of pulmonary infection (2.8% in the TLE group and 16.7% in the OA group). Incidences of complications, such as anastomotic leakage, cardiac complications, left-side hydrothorax, right-side pneumothorax, voice hoarse and incision infection, showed no statistical difference between two groups. Conclusion For patients with thoracic esophageal squamous cell carcinoma, TLE possesses advantages of more harvested lymph nodes, less blood loss and less pulmonary infection comparing with open approach, and is complied with the principles of security and oncological radicality of surgery.
With the continuous advancement and development of minimally invasive techniques, uniportal thoracoscopic minimally invasive esophagectomy (UTMIE) has gradually expanded its application in the surgical treatment of esophageal cancer due to its significant advantages, including minimal trauma, aesthetically pleasing incisions, and reduced postoperative pain. This consensus is based on the latest evidence-based medical data from both domestically and internationally, combined with extensive clinical practice experiences from numerous experts. It systematically reviews and summarizes the indications, key technical points, learning curve characteristics, perioperative management strategies, as well as prevention and management of complications associated with UTMIE. To ensure the scientific rigor and authority of this consensus, a total of 83 experts in the field were invited to participate in multiple rounds of Delphi surveys for in-depth discussion and consultation. Ultimately, 24 recommendations were formulated to guide the standardized application of UTMIE in clinical practice. The aim of this consensus is to standardize and guide the clinical implementation of UTMIE, ensuring safety and efficacy while promoting more efficient and widespread development of this surgical approach.
In this review, development and application of the minimally invasive esophagectomy(MIE) for esophageal cancer are discussed including the types of MIE procedures, short- and long- term outcome after MIE; as well the future of MIE is forecasted. Main procedures of MIE performed currently include esophagectomy via thoracoscopy and laparoscopy and cervical esophagogastrosty, Ivor-Lewis MIE via thoracoscopy and laparoscopy, and hiatal MIE. Ivor-Lewis MIE gradually becomes a standard surgical option for the cancer of distal esophagus or esophagogastric junction while the solution of intrathoracic anastomosis via thoracoscopy has achieved. Several methods of intrathoracic anastomosis are reported such as hand-sewn, circular stapler, side-to-side and triangular anastomosis. MIE could decrease operative blood loss, shorten hospital stay and ICU stay, reduce postoperative especially pulmonary complications, and harvest more lymph nodes compared to open esophagectomy. The long-term survival has been proved similar with that after open esophagectomy for esophageal cancer. MIE has developed rapidly in recent years with some aspects in future prospectively: individual MIE treatment and quality of life, fast track after surgery, and robot-assisted MIE, as well the endoscopic submucosal dissection for esophageal cancer is mentioned.
Objective To compare the short-term efficacy and safety of inflatable video-assisted mediastinoscopic transhiatal esophagectomy (IVMTE) and minimally invasive transthoracic esophagectomy (MITE) in the treatment of esophageal cancer. MethodsThe Cochrane Library, EMbase, PubMed, Wanfang Database, VIP, and CNKI were searched. Literatures related to the short-term efficacy and safety of IVMTE and MITE in the treatment of esophageal neoplasms published from the establishment of the database to December 2023 were searched and meta-analysis was conducted by using RevMan5.4. Quality of case control study or cohort study was assessed by the Newcastle-Ottawa Scale (NOS) and quality of randomized controlled trial was assessed by Cochrane Handbook. Results A total of 14 studies (12 case control studies and 1 prospective cohort study wiht NOS score more than 7 points and 1 randomized controlled trial wiht low bias risk) were included, comprising 1 163 patients, with 525 in the IVMTE group and 638 in the MITE group. The results of meta-analysis revealed that the IVMTE group exhibited significantly shorter operative time [MD=?60.42, 95%CI (?83.78, ?37.07), P<0.001] and postoperative hospital stay [MD=?2.44, 95%CI (?2.93, ?1.94), P<0.01] compared to the MITE group. Moreover, intraoperative blood loss [MD=?34.67, 95%CI (?59.11, ?10.23), P=0.005], three-day postoperative drainage [MD=?286.66, 95%CI (?469.93, ?103.40), P=0.002], incidence of postoperative pulmonary infection [OR=0.38, 95%CI (0.26, 0.56), P<0.001], lung leakage rate [OR=0.12, 95% CI (0.02, 0.63), P=0.01] and overall complication rate [MD=0.41, 95%CI (0.22, 0.75), P=0.004] were all lower in the IVMTE group compared to those in the MITE group. However, the MITE technique demonstrated superiority over IVMTE regarding intraoperative lymph dissection number [MD=?3.52, 95%CI (?6.36, –0.68), P=0.02] and intraoperative recurrent laryngeal nerve injury [OR=1.78, 95%CI (1.22, 2.60), P=0.003]. No significant difference was observed between both methods concerning anastomotic fistula. Conclusion Compared to MITE, IVMTE has advantages such as shorter operation time, less intraoperative blood loss, shorter hospital stay, less postoperative drainage within 3 days, and a lower incidence of pulmonary complications. In terms of laryngeal recurrent nerve injury and lymphatic dissection, MITE operation offers more benefits.
ObjectiveTo compare the short-term outcomes between Ivor Lewis esophagectomy and McKeown esophagectomy under thoracoscopy and laparoscopy for thoracic middle-lower esophageal carcinoma and to investigate the optimal approach.MethodsThe relevant literatures (from database foundation to March 2016) comparing minimally invasive Ivor Lewis esophagectomy and minimally invasive McKeown esophagectomy were searched through PubMed, EMbase, The Cochrane Library, CBM, CNKI, Wanfang Data and VIP. RevMan 5.3 software was used for data analysis.ResultsA total of 870 patients in 5 studies were reviewed and data were pooled for analysis. The score of Newcastle Ottawa for the literatures was 7-8 points. The results showed that compared with the McKeown group, Ivor Lewis group had shorter operation time (WMD=–34.67, 95% CI –53.70 to –15.65, P=0.000 4), less recurrent laryngeal nerve injuries (OR=0.23, 95% CI 0.12 to 0.44, P<0.000 01), anastomotic leakage (OR=0.24, 95% CI 0.14 to 0.41, P<0.000 01), anastomotic stenosis (OR=0.30, 95% CI 0.16 to 0.55, P=0.000 01), and pulmonary complications ( OR=0.25, 95% CI 0.15 to 0.43, P<0.000 01). There was no significant difference between the two groups in intraoperative blood loss, postoperative stay, hospitalization cost and chylothorax incidence. The McKeown group was associated with much more lymph nodes dissection (WMD=–1.16, 95% CI –2.00 to –0.31,P=0.007) than the Ivor Lewis group.ConclusionCompared with McKeown esophagectomy combined with thoracoscopy and laparoscopy, Ivor Lewis esophagectomy combined with thoracoscopy and laparoscopy has some advantages for thoracic middle-lower esophageal carcinoma, but a greater number of lymph nodes are dissected in McKeown procedure.