Analysis, Prevention and Treatment of Complications of 165 Patients with Thoracoscopic Esophagectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIXiao-xiang ,  LVBi-hong , HEGuang-ming , JIANGWei , XUXiang , HEJing , CHENRui

Department of Cardiothoracic Surgery, Taixing People’s Hospital Affiliated to Yangzhou University, Taixing 225400 Jiangshu, P.R.China;

Corresponding author：

LVBi-hong, Email: ZXXXX7576@163.com

Keywords：

Esophageal cancer; Thoracoscopic esophagectomy; Complications during and after operation; Prevention

DOI：

10.7507/1007-4848.20160081

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Objective To evaluate the characteristics and reasons of complications in the patients with thoracoscopic esophagectomy. Methods We retrospectively analyzed the clinical data of 165 patients with thoracoscopic esophagectomy in our hospital from January 2013 through January 2015. There were 102 males and 63 females at average age of 67.9±8.3 years. Results The operation time was 275.3±50.2 min. The intraoperative blood loss was 230.0±110.5 ml. The number of lymph node dissection was 18.1±6.5. The volume of drainage in thoracic cavity was 750±550 ml on the third day after operation. Thoracoscopic esophagectomy surgeries were successful except that 13 patients (7.8%) converted to open operation including 6 patients (4.2%) with severe pleural adhesion, 2 patients (1.2%) with hemorrhage, 2 patients (1.2%) with arrhythmia, and 3 patients (1.8%) with abnormal oxygenation. There were 17 patients (10.8%) were with intraoperative complications including 2 patients (1.2%) with arrhythmia, 3 patients (1.8%) with abnormal oxygenation, 7 patients (4.2%) with hemorrhage caused by vascular injury, 4 patients (2.4%) with thoracic duct injury, 1 patient (0.6%) with recurrent laryngeal nerve injury. Moreover, 46 patients (27.8%) experienced postoperative complications including 23 patients (13.9%) with pulmonary infection, 6 patients (3.6%) with hoarseness, 4 patients (2.4%) with anastomotic leakage, 3 patients (1.8%) with incision infection, 2 patients (1.2%) with tracheoesophageal fistula, and 2 patients (1.2%) with pneumothorax. Unexpectedly, five patients underwent re-operation due to chylothorax (n=3, 1.8%) and hemorrhage (n=2, 1.2%). One patient (0.06%) died of acute pulmonary embolism. Conclusion Serious adhesion in abdominal cavity, abnormal of lung and heart. And bleeding are the main reasons caused transferring open thoracic surgery operation in patients with thoracoscopic esophagectomy. Lung infection, hoarseness, and anastomotic leakage of neck are the most common postoperative complications. And acute pulmonary embolism is the main cause of postoperative death. Proper precautions to decrease the morbidity of complication are necessary.

Citation： XIXiao-xiang, LVBi-hong, HEGuang-ming, JIANGWei, XUXiang, HEJing, CHENRui. Analysis, Prevention and Treatment of Complications of 165 Patients with Thoracoscopic Esophagectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(4): 352-356. doi: 10.7507/1007-4848.20160081 Copy

1.	邹小农, 陈万青, 张思维, 等. 中国部分市县1998-2002年食管发病与死亡. 中国肿瘤, 2007, 16(3): 142-146.
2.	陈龙奇. 食管癌国际TNM分期解读与评价.中华肿瘤杂志, 2010, 32(3): 237-240.
3.	Pham TH, Perry KA, Dolan JP, et al. Comparison of perioperative outcomes after combined thoracoscomic-laparoscopic esophagec-tomy and open Ivor-lewis esophagectomy. Am J Sury, 2010, 199(5): 594-598.
4.	胡振东, 徐林, 冯纯伟等. 食管癌左胸径路全纵膈. 中华胸心血管外科杂志, 2009, 25(3): 202.
5.	Sun ZG, Wang Z. Clinical study on lymph node metastatic recurrence in patients with N0 esophageal squamous cell cancer. Dis Esophagus, 2011, 24(3): 182-188.
6.	Nsgatani S, Shimada Y, Kondo M, et al. A strategy for determing which thoracic esophageal cancer patients should undergo cervical lymph node dissection. Ann Thorac Surg, 2005, 80(5): 1881-1886.
7.	夏李明, 陈奇勋, 周星明, 等. 胸段食管癌喉返神经旁淋巴转移的影响因素. 中国肿瘤, 2006, 15(11): 782-784.
8.	Osugi H, Takemura M, Higashino M, et al. Learning curve of video-assisted thoracoscopic esophagectomy and extensive lymphade-nectomy for squamous cell cancer of the thoracic esophagus and re-suits. Surg Endosc, 2003, 17: 515-519.
9.	张真铭, 王允, 高永山等. 微创手术治疗食管癌160例临床分析. 中华胃肠外科杂志, 2012, 9: 934-937.
10.	Avendano CE, Flume PA, Silvestri GA, et a1. Pulmonary complications after esophagectomy. Ann Thorac Surg, 2002, 73: 922-926.
11.	龚太乾, 蒋耀光, 王如文等. 食管癌术后早期并发症及死亡原因分析. 中国胸心血管外科临床杂志, 2005, 12: 173-176.
12.	Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg, 2012, 256: 95-103.
13.	Rizk NP, Bach PB, Schrag D, et al. The impact of complications on outcomes after resection for esophageal and gastroesophageal junction carcinoma. J Am Coil Surg, 2004, 198: 42-50.
14.	Guo W, Zhao YP, Jiang YG, et al. Prevention of postoperative chylothorax with thoracic duct ligation during video-assisted thoracoscopic esophagectomy for cancer. Surg Endosc, 2012, 26: 1332-1336.
15.	郭明, 胡蒙, 孙晓雁, 等. 全胸腔镜联合非气腹腹腔镜辅助食管癌根治术与常规手术的对比研究. 中国微创外科杂志, 2012, 12(1): 53-56.
16.	Whooley BP, Law S, Alexandrou A, et al. Critical appraisal of the significance of intrathoracic anastomotic leakage after esophagectomy for cancer. Am J Surg, 2001, 181(3): 198-203.
17.	Mailer JM, Erasmi H, Stelzner M, et al. Surgical therapy of oeso-phageal carcinoma. Br J Surg, 1990, 77: 845-857.
18.	Patil PK, Patel SG, Mistry RC, et al. Cancer of the esophagus in young adults. J Surg Oncol, 1992, 50(3): 179-182.
19.	De Martino RR, Goodney PP, Spangler EL, et al. Variation in throm boembolic complications among patients undergoing commonly performed cancer operations. J Vasc Surg, 2012, 55(4): 1035-1040.
20.	朱成楚, 陈仕林, 叶敏华, 等. 电视胸腔镜下行食管癌手术胸部淋巴结清扫. 中华外科杂志, 2005, 43(10): 628-630.

1. 邹小农, 陈万青, 张思维, 等. 中国部分市县1998-2002年食管发病与死亡. 中国肿瘤, 2007, 16(3): 142-146.
2. 陈龙奇. 食管癌国际TNM分期解读与评价.中华肿瘤杂志, 2010, 32(3): 237-240.
3. Pham TH, Perry KA, Dolan JP, et al. Comparison of perioperative outcomes after combined thoracoscomic-laparoscopic esophagec-tomy and open Ivor-lewis esophagectomy. Am J Sury, 2010, 199(5): 594-598.
4. 胡振东, 徐林, 冯纯伟等. 食管癌左胸径路全纵膈. 中华胸心血管外科杂志, 2009, 25(3): 202.
5. Sun ZG, Wang Z. Clinical study on lymph node metastatic recurrence in patients with N0 esophageal squamous cell cancer. Dis Esophagus, 2011, 24(3): 182-188.
6. Nsgatani S, Shimada Y, Kondo M, et al. A strategy for determing which thoracic esophageal cancer patients should undergo cervical lymph node dissection. Ann Thorac Surg, 2005, 80(5): 1881-1886.
7. 夏李明, 陈奇勋, 周星明, 等. 胸段食管癌喉返神经旁淋巴转移的影响因素. 中国肿瘤, 2006, 15(11): 782-784.
8. Osugi H, Takemura M, Higashino M, et al. Learning curve of video-assisted thoracoscopic esophagectomy and extensive lymphade-nectomy for squamous cell cancer of the thoracic esophagus and re-suits. Surg Endosc, 2003, 17: 515-519.
9. 张真铭, 王允, 高永山等. 微创手术治疗食管癌160例临床分析. 中华胃肠外科杂志, 2012, 9: 934-937.
10. Avendano CE, Flume PA, Silvestri GA, et a1. Pulmonary complications after esophagectomy. Ann Thorac Surg, 2002, 73: 922-926.
11. 龚太乾, 蒋耀光, 王如文等. 食管癌术后早期并发症及死亡原因分析. 中国胸心血管外科临床杂志, 2005, 12: 173-176.
12. Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg, 2012, 256: 95-103.
13. Rizk NP, Bach PB, Schrag D, et al. The impact of complications on outcomes after resection for esophageal and gastroesophageal junction carcinoma. J Am Coil Surg, 2004, 198: 42-50.
14. Guo W, Zhao YP, Jiang YG, et al. Prevention of postoperative chylothorax with thoracic duct ligation during video-assisted thoracoscopic esophagectomy for cancer. Surg Endosc, 2012, 26: 1332-1336.
15. 郭明, 胡蒙, 孙晓雁, 等. 全胸腔镜联合非气腹腹腔镜辅助食管癌根治术与常规手术的对比研究. 中国微创外科杂志, 2012, 12(1): 53-56.
16. Whooley BP, Law S, Alexandrou A, et al. Critical appraisal of the significance of intrathoracic anastomotic leakage after esophagectomy for cancer. Am J Surg, 2001, 181(3): 198-203.
17. Mailer JM, Erasmi H, Stelzner M, et al. Surgical therapy of oeso-phageal carcinoma. Br J Surg, 1990, 77: 845-857.
18. Patil PK, Patel SG, Mistry RC, et al. Cancer of the esophagus in young adults. J Surg Oncol, 1992, 50(3): 179-182.
19. De Martino RR, Goodney PP, Spangler EL, et al. Variation in throm boembolic complications among patients undergoing commonly performed cancer operations. J Vasc Surg, 2012, 55(4): 1035-1040.
20. 朱成楚, 陈仕林, 叶敏华, 等. 电视胸腔镜下行食管癌手术胸部淋巴结清扫. 中华外科杂志, 2005, 43(10): 628-630.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis, Prevention and Treatment of Complications of 165 Patients with Thoracoscopic Esophagectomy

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