Conversion to thoracotomy during minimally invasive esophagectomy: Retrospective analysis in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LV Huilai , XU Shi , WANG Mingbo , LI Zhenhua , LIU Zhao , LI Jiachen , HUANG Chao , ZHANG Fan , GAI Chunyue ,  TIAN Ziqiang

Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, P. R. China;

Corresponding author：

TIAN Ziqiang, Email: tizq12@vip.163.com

Keywords：

Minimally invasive esophagectomy; conversion to thoracotomy; reason analysis; perioperative mortality

DOI：

10.7507/1007-4848.202211056

Video：

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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.

Citation： LV Huilai, XU Shi, WANG Mingbo, LI Zhenhua, LIU Zhao, LI Jiachen, HUANG Chao, ZHANG Fan, GAI Chunyue, TIAN Ziqiang. Conversion to thoracotomy during minimally invasive esophagectomy: Retrospective analysis in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(6): 879-883. doi: 10.7507/1007-4848.202211056 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	Sohda M, Kuwano H. Current status and future prospects for esophageal cancer treatment. Ann Thorac Cardiovasc Surg, 2017, 23(1): 1-11.
3.	Schröder W, Gisbertz SS, Voeten DM, et al. Surgical therapy of esophageal adenocarcinoma—Current standards and future perspectives. Cancers (Basel), 2021, 13(22): 5834.
4.	Waters JK, Reznik SI. Update on management of squamous cell esophageal cancer. Curr Oncol Rep, 2022, 24(3): 375-385.
5.	Pu S, Chen H, Zhou C, et al. Major postoperative complications in esophageal cancer after minimally invasive esophagectomy compared with open esophagectomy: An updated meta-analysis. J Surg Res, 2021, 257: 554-571.
6.	Yoshida N, Yamamoto H, Baba H, et al. Can minimally invasive esophagectomy replace open esophagectomy for esophageal cancer? Latest analysis of 24, 233 esophagectomies from the Japanese National Clinical Database. Ann Surg, 2020, 272(1): 118-124.
7.	Sakamoto T, Fujiogi M, Matsui H, et al. Comparing perioperative mortality and morbidity of minimally invasive esophagectomy versus open esophagectomy for esophageal cancer: A nationwide retrospective analysis. Ann Surg, 2021, 274(2): 324-330.
8.	Gottlieb-Vedi E, Kauppila JH, Mattsson F, et al. Long-term survival in esophageal cancer after minimally invasive esophagectomy compared to open esophagectomy. Ann Surg, 2022, 276(6): e744-e748.
9.	Hayami M, Ndegwa N, Lindblad M, et al. Population-based cohort study from a prospective national registry: Better long-term survival in esophageal cancer after minimally invasive compared with open transthoracic esophagectomy. Ann Surg Oncol, 2022, 29(9): 5609-5621.
10.	Wang K, Zhong J, Liu Q, et al. A propensity score-matched analysis of thoracolaparoscopic vs open McKeown's esophagectomy. Ann Thorac Surg, 2022, 113(2): 473-481.
11.	Bras Harriott C, Angeramo CA, Casas MA, et al. Open versus hybrid versus totally minimally invasive Ivor Lewis esophagectomy: Systematic review and meta-analysis. J Thorac Cardiovasc Surg, 2022, 164(6): e233-e254.
12.	Dyas AR, Stuart CM, Bronsert MR, et al. Minimally invasive surgery is associated with decreased postoperative complications after esophagectomy. J Thorac Cardiovasc Surg, 2022, S0022-5223(22): 01269-7.
13.	Xie J, Zhang L, Liu Z, et al. Advantages of McKeown minimally invasive oesophagectomy for the treatment of oesophageal cancer: Propensity score matching analysis of 169 cases. World J Surg Oncol, 2022, 20(1): 52.
14.	Gergen AK, Halpern AL, Helmkamp L, et al. Outcomes after converted minimally invasive to open esophagectomy in patients with esophageal cancer. Ann Thorac Surg, 2021, 112(5): 1593-1599.
15.	Halpern AL, Friedman C, Torphy RJ, et al. Conversion to open surgery during minimally invasive esophagectomy portends worse short-term outcomes: An analysis of the National Cancer Database. Surg Endosc, 2020, 34(8): 3470-3478.
16.	Liu XH, Hu Y, Li KK, et al. Intraoperative conversion does not affect the oncological outcomes of minimally invasive esophagectomy for treatment of esophageal cancer. Surg Endosc, 2018, 32(11): 4517-4526.
17.	Koyanagi K, Ozawa S, Tachimori Y. Minimally invasive esophagectomy performed with the patient in a prone position: A systematic review. Surg Today, 2016, 46(3): 275-284.
18.	Silva JP, Putnam LR, Wu J, et al. Lower rates of unplanned conversion to open in robotic approach to esophagectomy for cancer. Am Surg, 2022, 31348221104249.
19.	郑晓东, 张卫民, 侯建彬, 等. 电视胸腔镜食管癌切除术围术期并发症分析及预防. 中国微创外科杂志, 2019, 19(6): 526-530.
20.	奚小祥, 吕必宏, 何光明, 等. 胸腔镜下食管癌根治术165例患者的并发症分析与防治. 中国胸心血管外科临床杂志, 2016, 23(4): 352-356.
21.	张霓, 徐沁孜, 蔡奕欣, 等. 全胸腔镜食管癌外科治疗的手术模式及其演变. 中华胸心血管外科杂志, 2013, 29(6): 323-325, 357.
22.	Fuchs HF, Harnsberger CR, Broderick RC, et al. Mortality after esophagectomy is heavily impacted by center volume: Retrospective analysis of the Nationwide Inpatient Sample. Surg Endosc, 2017, 31(6): 2491-2497.
23.	van Workum F, Stenstra MHBC, Berkelmans GHK, et al. Learning curve and associated morbidity of minimally invasive esophagectomy: A retrospective multicenter study. Ann Surg, 2019, 269(1): 88-94.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Sohda M, Kuwano H. Current status and future prospects for esophageal cancer treatment. Ann Thorac Cardiovasc Surg, 2017, 23(1): 1-11.
3. Schröder W, Gisbertz SS, Voeten DM, et al. Surgical therapy of esophageal adenocarcinoma—Current standards and future perspectives. Cancers (Basel), 2021, 13(22): 5834.
4. Waters JK, Reznik SI. Update on management of squamous cell esophageal cancer. Curr Oncol Rep, 2022, 24(3): 375-385.
5. Pu S, Chen H, Zhou C, et al. Major postoperative complications in esophageal cancer after minimally invasive esophagectomy compared with open esophagectomy: An updated meta-analysis. J Surg Res, 2021, 257: 554-571.
6. Yoshida N, Yamamoto H, Baba H, et al. Can minimally invasive esophagectomy replace open esophagectomy for esophageal cancer? Latest analysis of 24, 233 esophagectomies from the Japanese National Clinical Database. Ann Surg, 2020, 272(1): 118-124.
7. Sakamoto T, Fujiogi M, Matsui H, et al. Comparing perioperative mortality and morbidity of minimally invasive esophagectomy versus open esophagectomy for esophageal cancer: A nationwide retrospective analysis. Ann Surg, 2021, 274(2): 324-330.
8. Gottlieb-Vedi E, Kauppila JH, Mattsson F, et al. Long-term survival in esophageal cancer after minimally invasive esophagectomy compared to open esophagectomy. Ann Surg, 2022, 276(6): e744-e748.
9. Hayami M, Ndegwa N, Lindblad M, et al. Population-based cohort study from a prospective national registry: Better long-term survival in esophageal cancer after minimally invasive compared with open transthoracic esophagectomy. Ann Surg Oncol, 2022, 29(9): 5609-5621.
10. Wang K, Zhong J, Liu Q, et al. A propensity score-matched analysis of thoracolaparoscopic vs open McKeown's esophagectomy. Ann Thorac Surg, 2022, 113(2): 473-481.
11. Bras Harriott C, Angeramo CA, Casas MA, et al. Open versus hybrid versus totally minimally invasive Ivor Lewis esophagectomy: Systematic review and meta-analysis. J Thorac Cardiovasc Surg, 2022, 164(6): e233-e254.
12. Dyas AR, Stuart CM, Bronsert MR, et al. Minimally invasive surgery is associated with decreased postoperative complications after esophagectomy. J Thorac Cardiovasc Surg, 2022, S0022-5223(22): 01269-7.
13. Xie J, Zhang L, Liu Z, et al. Advantages of McKeown minimally invasive oesophagectomy for the treatment of oesophageal cancer: Propensity score matching analysis of 169 cases. World J Surg Oncol, 2022, 20(1): 52.
14. Gergen AK, Halpern AL, Helmkamp L, et al. Outcomes after converted minimally invasive to open esophagectomy in patients with esophageal cancer. Ann Thorac Surg, 2021, 112(5): 1593-1599.
15. Halpern AL, Friedman C, Torphy RJ, et al. Conversion to open surgery during minimally invasive esophagectomy portends worse short-term outcomes: An analysis of the National Cancer Database. Surg Endosc, 2020, 34(8): 3470-3478.
16. Liu XH, Hu Y, Li KK, et al. Intraoperative conversion does not affect the oncological outcomes of minimally invasive esophagectomy for treatment of esophageal cancer. Surg Endosc, 2018, 32(11): 4517-4526.
17. Koyanagi K, Ozawa S, Tachimori Y. Minimally invasive esophagectomy performed with the patient in a prone position: A systematic review. Surg Today, 2016, 46(3): 275-284.
18. Silva JP, Putnam LR, Wu J, et al. Lower rates of unplanned conversion to open in robotic approach to esophagectomy for cancer. Am Surg, 2022, 31348221104249.
19. 郑晓东, 张卫民, 侯建彬, 等. 电视胸腔镜食管癌切除术围术期并发症分析及预防. 中国微创外科杂志, 2019, 19(6): 526-530.
20. 奚小祥, 吕必宏, 何光明, 等. 胸腔镜下食管癌根治术165例患者的并发症分析与防治. 中国胸心血管外科临床杂志, 2016, 23(4): 352-356.
21. 张霓, 徐沁孜, 蔡奕欣, 等. 全胸腔镜食管癌外科治疗的手术模式及其演变. 中华胸心血管外科杂志, 2013, 29(6): 323-325, 357.
22. Fuchs HF, Harnsberger CR, Broderick RC, et al. Mortality after esophagectomy is heavily impacted by center volume: Retrospective analysis of the Nationwide Inpatient Sample. Surg Endosc, 2017, 31(6): 2491-2497.
23. van Workum F, Stenstra MHBC, Berkelmans GHK, et al. Learning curve and associated morbidity of minimally invasive esophagectomy: A retrospective multicenter study. Ann Surg, 2019, 269(1): 88-94.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Conversion to thoracotomy during minimally invasive esophagectomy: Retrospective analysis in a single center

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