Single-port inflatable mediastinoscope-assisted transhiatal esophagectomy versus functional minimally invasive esophagectomy for esophageal cancer: A propensity score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Qian ^1,2 , LIU Huibing ¹ , ZHANG Luchang ^3,4 , JIN Defeng ^3,4 , CUI Zhaoqing ^3,4 , NI Haiyang ² ,  WEI Yutao ^3,4

1. Department of Thoracic and Cardiovascular Surgery, Nantong No.1 People’s Hospital, Nantong, 226000, Jiangsu, P. R. China;
2. School of Clinical Medicine, Jining Medical University, Jining, 272000, Shandong, P. R. China;
3. Department of Thoracic Surgery, Jining No.1 People’s Hospital, Jining, 272000, Shandong, P. R. China;
4. Institute of Thoracic Surgery, Jining Institute of Medical Sciences, Jining, 272000, Shandong, P. R. China;

Corresponding author：

WEI Yutao, Email: wytgyh@163.com

Keywords：

Esophageal carcinoma; minimally invasive esophagectomy; mediastinoscopy; propensity score matching

DOI：

10.7507/1007-4848.202210091

Video：

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Objective To compare the efficacy of mediastinoscope-assisted transhiatal esophagectomy (MATHE) and functional minimally invasive esophagectomy (FMIE) for esophageal cancer. Methods Patients who underwent minimally invasive esophagectomy at Jining No.1 Hospital from March 2018 to September 2022 were retrospectively included. The patients were divided into a MATHE group and a FMIE group according to the procedures. The patients were matched via propensity score matching (PSM) with a ratio of 1 : 1 and a caliper value of 0.2. The clinical data of the patients were compared after the matching. Results A total of 73 patients were include in the study, including 54 males and 19 females, with an average age of (65.12±7.87) years. There were 37 patients in the MATHE group and 36 patients in the FMIE group. Thirty pairs were successfully matched. Compared with the FMIE group, MATHE group had shorter operation time (P=0.022), lower postoperative 24 h pain score (P=0.031), and less drainage on postoperative 1-3 days (P<0.001). FMIE group had more lymph node dissection (P<0.001), lower incidence of postoperative hoarseness (P=0.038), lower white blood cell and neutrophil counts on postoperative 1 day (P<0.001). There was no statistically significant difference in the bleeding volume, R0 resection, hospital mortality, postoperative hospital stay, anastomotic leak, chylothorax, or pulmonary infection between the two groups (P>0.05). Conclusion Compared with the FMIE, MATHE has shorter operation time, less postoperative pain and drainage, but removes less lymph nodes, which is deficient in oncology. For some special patients such as those with early cancer or extensive pleural adhesions, MATHE may be a suitable surgical method.

Citation： WANG Qian, LIU Huibing, ZHANG Luchang, JIN Defeng, CUI Zhaoqing, NI Haiyang, WEI Yutao. Single-port inflatable mediastinoscope-assisted transhiatal esophagectomy versus functional minimally invasive esophagectomy for esophageal cancer: A propensity score matching study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(11): 1625-1631. doi: 10.7507/1007-4848.202210091 Copy

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	Cao W, Chen HD, Yu YW, et al. Changing profiles of cancer burden worldwide and in China: A secondary analysis of the global cancer statistics 2020. Chin Med J (Engl), 2021, 134(7): 783-791.
3.	Barbat JH. Thoracic esophagectomy: Report of a case. Cal State J Med, 1913, 11(6): 225-227.
4.	Liu H, Jin D, Wang Q, et al. Perioperative safety and short-term efficacy of functional minimally invasive esophagectomy. J Int Med Res, 2021, 49(5): 3000605211010081.
5.	Liu W, Guo X, Zhao H, et al. Mediastinoscopy-assisted transhiatal esophagectomy versus thoraco-laparoscopic esophagectomy for esophageal cancer: A single-center initial experience. J Thorac Dis, 2020, 12(9): 4908-4914.
6.	Rezaei R, Masuom SHF, Soroush N, et al. Comparison of transhiatal esophagectomy using a mediastinoscope with transhiatal esophagectomy by the classic method. Asian Cardiovasc Thorac Ann, 2021, 29(1): 33-37.
7.	李金蔓. 食管癌术后并发症分级及其影响因素分析. 中国胸心血管外科临床杂志, 2017, 24(4): 259-264.Li JM. Clavien-Dindo classification of postoperative complications and its influencing factorsin patients receiving esophagectomy. Chin J Clin Thorac Cardiovasc Surg, 2017, 24(4): 259-264.
8.	Mboumi IW, Reddy S, Lidor AO. Complications after esophagectomy. Surg Clin North Am, 2019, 99(3): 501-510.
9.	Aoyama T, Kazama K, Atsumi Y, et al. Clinical influence of anastomotic leakage on esophageal cancer survival and recurrence. Anticancer Res, 2020, 40(1): 443-449.
10.	Vrba R, Kučová P, Ľubušká L, et al. Bacterial complications in surgical management of esophageal cancer. Klin Mikrobiol Infekc Lek, 2021, 27(3): 93-97.
11.	Murthy RA, Clarke NS, Kernstine KH. Minimally invasive and robotic esophagectomy: A review. Innovations (Phila), 2018, 13(6): 391-403.
12.	Kanekiyo S, Takeda S, Tsutsui M, et al. Low invasiveness of thoracoscopic esophagectomy in the prone position for esophageal cancer: A propensity score-matched comparison of operative approaches between thoracoscopic and open esophagectomy. Surg Endosc, 2018, 32(4): 1945-1953.
13.	Gottlieb-Vedi E, Kauppila JH, Malietzis G, et al. Long-term survival in esophageal cancer after minimally invasive compared to open esophagectomy: A systematic review and meta-analysis. Ann Surg, 2019, 270(6): 1005-1017.
14.	Zheng Y, Li Y, Liu X, et al. Minimally invasive versus open mckeown for patients with esophageal cancer: A retrospective study. Ann Surg Oncol, 2021, 28(11): 6329-6336.
15.	Bumm R, Hölscher AH, Feussner H, et al. Endodissection of the thoracic esophagus. Technique and clinical results in transhiatal esophagectomy. Ann Surg, 1993, 218(1): 97-104.
16.	Guo L, Zhao Q, Wang K, et al. A case-control study on the therapeutic effect of mediastinoscope-assisted and thoracoscope-assisted esophagectomy. Surg Innov, 2021, 28(3): 316-322.
17.	Feng MX, Wang H, Zhang Y, et al. Minimally invasive esophagectomy for esophageal squamous cell carcinoma: A case-control study of thoracoscope versus mediastinoscope assistance. Surg Endosc, 2012, 26(6): 1573-1578.
18.	Aoyama J, Kawakubo H, Mayanagi S, et al. Discrepancy between the clinical and final pathological findings of lymph node metastasis in superficial esophageal cancer. Ann Surg Oncol, 2019, 26(9): 2874-2881.
19.	Zheng YZ, Li XQ, Wang JY, et al. Impact of examined lymph node count for esophageal squamous cell carcinoma in patients who underwent right transthoracic esophagectomy. Ann Surg Oncol, 2021, 28(6): 3025-3033.
20.	Yu L, Zhang XT, Guan SH, et al. The number of negative lymph nodes is positively associated with survival in esophageal squamous cell carcinoma patients in China. Open Med (Wars), 2020, 15: 152-159.
21.	Lord JM, Midwinter MJ, Chen YF, et al. The systemic immune response to trauma: An overview of pathophysiology and treatment. Lancet, 2014, 384(9952): 1455-1465.
22.	Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: A multicentre, open-label, randomised controlled trial. Lancet, 2012, 379(9829): 1887-1892.
23.	Fabian T. Management of postoperative complications after esophageal resection. Surg Clin North Am, 2021, 101(3): 525-539.
24.	Verstegen MHP, Bouwense SAW, van Workum F, et al. Management of intrathoracic and cervical anastomotic leakage after esophagectomy for esophageal cancer: A systematic review. World J Emerg Surg, 2019, 14: 17.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. Cao W, Chen HD, Yu YW, et al. Changing profiles of cancer burden worldwide and in China: A secondary analysis of the global cancer statistics 2020. Chin Med J (Engl), 2021, 134(7): 783-791.
3. Barbat JH. Thoracic esophagectomy: Report of a case. Cal State J Med, 1913, 11(6): 225-227.
4. Liu H, Jin D, Wang Q, et al. Perioperative safety and short-term efficacy of functional minimally invasive esophagectomy. J Int Med Res, 2021, 49(5): 3000605211010081.
5. Liu W, Guo X, Zhao H, et al. Mediastinoscopy-assisted transhiatal esophagectomy versus thoraco-laparoscopic esophagectomy for esophageal cancer: A single-center initial experience. J Thorac Dis, 2020, 12(9): 4908-4914.
6. Rezaei R, Masuom SHF, Soroush N, et al. Comparison of transhiatal esophagectomy using a mediastinoscope with transhiatal esophagectomy by the classic method. Asian Cardiovasc Thorac Ann, 2021, 29(1): 33-37.
7. 李金蔓. 食管癌术后并发症分级及其影响因素分析. 中国胸心血管外科临床杂志, 2017, 24(4): 259-264.Li JM. Clavien-Dindo classification of postoperative complications and its influencing factorsin patients receiving esophagectomy. Chin J Clin Thorac Cardiovasc Surg, 2017, 24(4): 259-264.
8. Mboumi IW, Reddy S, Lidor AO. Complications after esophagectomy. Surg Clin North Am, 2019, 99(3): 501-510.
9. Aoyama T, Kazama K, Atsumi Y, et al. Clinical influence of anastomotic leakage on esophageal cancer survival and recurrence. Anticancer Res, 2020, 40(1): 443-449.
10. Vrba R, Kučová P, Ľubušká L, et al. Bacterial complications in surgical management of esophageal cancer. Klin Mikrobiol Infekc Lek, 2021, 27(3): 93-97.
11. Murthy RA, Clarke NS, Kernstine KH. Minimally invasive and robotic esophagectomy: A review. Innovations (Phila), 2018, 13(6): 391-403.
12. Kanekiyo S, Takeda S, Tsutsui M, et al. Low invasiveness of thoracoscopic esophagectomy in the prone position for esophageal cancer: A propensity score-matched comparison of operative approaches between thoracoscopic and open esophagectomy. Surg Endosc, 2018, 32(4): 1945-1953.
13. Gottlieb-Vedi E, Kauppila JH, Malietzis G, et al. Long-term survival in esophageal cancer after minimally invasive compared to open esophagectomy: A systematic review and meta-analysis. Ann Surg, 2019, 270(6): 1005-1017.
14. Zheng Y, Li Y, Liu X, et al. Minimally invasive versus open mckeown for patients with esophageal cancer: A retrospective study. Ann Surg Oncol, 2021, 28(11): 6329-6336.
15. Bumm R, Hölscher AH, Feussner H, et al. Endodissection of the thoracic esophagus. Technique and clinical results in transhiatal esophagectomy. Ann Surg, 1993, 218(1): 97-104.
16. Guo L, Zhao Q, Wang K, et al. A case-control study on the therapeutic effect of mediastinoscope-assisted and thoracoscope-assisted esophagectomy. Surg Innov, 2021, 28(3): 316-322.
17. Feng MX, Wang H, Zhang Y, et al. Minimally invasive esophagectomy for esophageal squamous cell carcinoma: A case-control study of thoracoscope versus mediastinoscope assistance. Surg Endosc, 2012, 26(6): 1573-1578.
18. Aoyama J, Kawakubo H, Mayanagi S, et al. Discrepancy between the clinical and final pathological findings of lymph node metastasis in superficial esophageal cancer. Ann Surg Oncol, 2019, 26(9): 2874-2881.
19. Zheng YZ, Li XQ, Wang JY, et al. Impact of examined lymph node count for esophageal squamous cell carcinoma in patients who underwent right transthoracic esophagectomy. Ann Surg Oncol, 2021, 28(6): 3025-3033.
20. Yu L, Zhang XT, Guan SH, et al. The number of negative lymph nodes is positively associated with survival in esophageal squamous cell carcinoma patients in China. Open Med (Wars), 2020, 15: 152-159.
21. Lord JM, Midwinter MJ, Chen YF, et al. The systemic immune response to trauma: An overview of pathophysiology and treatment. Lancet, 2014, 384(9952): 1455-1465.
22. Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: A multicentre, open-label, randomised controlled trial. Lancet, 2012, 379(9829): 1887-1892.
23. Fabian T. Management of postoperative complications after esophageal resection. Surg Clin North Am, 2021, 101(3): 525-539.
24. Verstegen MHP, Bouwense SAW, van Workum F, et al. Management of intrathoracic and cervical anastomotic leakage after esophagectomy for esophageal cancer: A systematic review. World J Emerg Surg, 2019, 14: 17.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Single-port inflatable mediastinoscope-assisted transhiatal esophagectomy versus functional minimally invasive esophagectomy for esophageal cancer: A propensity score matching study

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