Early Experience of Combined Laparoscopic and Thoracoscopic Esophagectomy and Intrathoracic Esophagogastric Anastomosis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YOU Bin , LI Hui , HOU Shengcai , HU Bin.

Department of Thoracic Surgery， Beijing Chaoyang Hospital，　Capital Medical University， Beijing 100020， P. R. China;

Corresponding author：

Keywords：

Esophageal cancer; 　Ivor Lewis esophagectomy; 　Minimally invasive surgery

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Abstract:　Objective　To evaluate the feasibility and safety of combined laparoscopic and thoracoscopic esophagectomy　and intrathoracic esophagogastric anastomosis for the treatment of esophageal cancer.　Methods　We retrospectively analyzed clinical data of 40 patients with esophageal cancer who underwent esophagectomy in Beijing Chaoyang Hospital of Capital Medical University from March 2010 to March 2012. All the 40 patients were divided into 2 groups according　to their different surgical approach， including 22 patients who underwent combined laparoscopic and thoracoscopic　esophagectomy and intrathoracic esophagogastric anastomosis （minimally invasive surgery group） and 18 patients who　underwent Ivor Lewis esophagectomy （open surgery group）. Operation time， intra-operative blood loss， lymph node　dissection， postoperative morbidity， hospital stay and cost were compared between the two groups.　Results　The hospital
cost of minimally invasive surgery group was significantly higher than that of open surgery group ［（78 181.5±8 958.8）　yuan vs. （61 717.2±35 159.4） yuan， Z=4.078，P=0.000］ . There was no statistical difference in operation time ［（292.0±74.8） min vs. （256.1±41.0） min， t=1.838，P=0.074］， intra-operative blood loss ［（447.7±597.0） ml vs. （305.6±125.9） ml，　Z=0.401，P=0.688］， total number of dissected lymph nodes （230 vs. 215， t=1.714，P=0.095），　postoperative morbidity ［22.7% （5/22） vs. 33.3% （6/18）， χ2=0.559，P=0.498］， time to resume oral intake ［（8.5±3.5） d vs. （11.1±9.6） d，t=1.202，P=0.237］， and postoperative hospital stay ［（11.6±5.7） d vs. （13.3±9.4） d， t=0.680， P=0.501）］ between the two groups. The minimally invasive surgery group was further divided into two subgroups according to　operation date， including 10 patients in the early stage subgroup and 12 patients in the later stage subgroup. The operation　time of the later stage subgroup was significantly shorter than that of the early stage subgroup ［（262.9±64.9） min vs. （327.5±73.0） min， t=2.197， P=0.040］， but not statistically different from that of the open surgery group ［（262.9±64.9） min vs. （256.1 ±41.0） min， t=0.353， P=0.727］. Intra-operative blood loss of the later stage subgroup was significantly reduced compared with those of the early stage subgroup ［（220.8±149.9） ml vs. （720.0±808.0） ml， Z=3.279， P=0.001)］ and the open surgery group ［（220.8±149.9）ml vs. （305.6±125.9） ml， Z=2.089， P=0.037）］.　Conclusion　Combined laparoscopic and thoracoscopic esophagectomy and intrathoracic esophagogastric anastomosis is a safe and effective surgical　procedure for the treatment of esophageal cancer.

Citation： YOU Bin,LI Hui,HOU Shengcai,HU Bin.. Early Experience of Combined Laparoscopic and Thoracoscopic Esophagectomy and Intrathoracic Esophagogastric Anastomosis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(6): 624-628. doi: Copy

1.	Maas KW， Biere SS， Scheepers JJ， et al. Minimally invasive　intrathoracic anastomosis after Ivor Lewis esophagectomy for cancer：a review of transoral or transthoracic use of staplers. Surg Endosc， 2012， 26 （7）：1795-1802.
2.	Hoppo T， Jobe BA， Hunter JG. Minimally invasive esophagectomy：the evolution and technique of minimally invasive surgery for esophageal cancer. World J Surg， 2011， 35 （7）：1454-1463.
3.	Allen MS. Ivor Lewis esophagectomy. Semin Thorac Cardiovasc Surg， 1992， 4 （4）：320-323.
4.	Bains MS. Ivor Lewis esophagectomy. Chest Surg Clin N Am， 1995， 5 （3）：515-526.
5.	Marangoni G， Villa F， Shamil E， et al. OrVilTM-assisted anastomosis in laparoscopic upper gastrointestinal surgery：friend of the laparoscopic surgeon. Surg Endosc， 2012， 26 （3）：811-817.
6.	Campos GM， Jablons D， Brown LM， et al. A safe and reproducible anastomotic technique for minimally invasive Ivor Lewis oesophagectomy：the circular-stapled anastomosis with the trans-oral anvil. Eur J Cardiothorac Surg， 2010， 37 （6）：1421-1426.
7.	Jaroszewski DE， Williams DG， Fleischer DE， et al. An early experience using the technique of transoral OrVil EEA stapler for minimally invasive transthoracic esophagectomy. Ann Thorac Surg， 2011， 92 （5）：1862-1869.
8.	Luketich JD， Pennathur A， Awais O， et al. Outcomes after minimally invasive esophagectomy：review of over 1000 patients. Ann Surg， 2012， 256 （1）：95-103.
9.	Berger AC， Bloomenthal A， Weksler B， et al. Oncologic efficacy is not compromised， and may be improved with minimally invasive　esophagectomy. J Am Coll Surg， 2011， 212 （4）：560-566.
10.	Li H， Hu B， You B， et al. Completely minimally invasive Ivor Lewis esophagectomy：the preliminary experience of circular-stapled anastomosis with the trans-oral anvil. Zhonghua Wai Ke Za Zhi， 2010， 48 （22）：1747-1750.
11.	Ben-David K， Sarosi GA， Cendan JC， et al. Technique of minimally invasive Ivor Lewis esophagogastrectomy with intrathoracic stapled side-to-side anastomosis. J Gastrointest Surg， 2010， 14 （10）：1613-1618.
12.	Bonavina L， Laface L， Abate E， et al. Comparison of ventilation and cardiovascular parameters between prone thoracoscopic and Ivor Lewis esophagectomy. Updates Surg， 2012， 64 （2）：81-85.
13.	Bakhos CT， Fabian T， Oyasiji TO， et al. Impact of the surgical technique on pulmonary morbidity after esophagectomy. Ann Thorac Surg， 2012， 93 （1）：221-226.
14.	Atkins BZ， Shah AS， Hutcheson KA， et al. Reducing hospital　morbidity and mortality following esophagectomy. Ann Thorac Surg， 2004， 78 （4）：1170 -1176 .
15.	Pham TH， Perry KA， Dolan JP， et al. Comparison of perioperative outcomes after combined thoracoscopic-laparoscopic esophagectomy and open Ivor-Lewis esophagectomy. Am J Surg， 2010， 199 （5）：594-598.
16.	Hamouda AH， Forshaw MJ， Tsigritis K， et al. Perioperative　outcomes after transition from conventional to minimally invasive Ivor-Lewis esophagectomy in a specialized center. Surg Endosc， 2010， 24 （4）：865-869.
17.	Kinjo Y， Kurita N， Nakamura F， et al. Effectiveness of combined thoracoscopic-laparoscopic esophagectomy：comparison of postoperative complications and midterm oncological outcomes in patients with esophageal cancer. Surg Endosc， 2012， 26 （2）：381-390.

1. 　Maas KW， Biere SS， Scheepers JJ， et al. Minimally invasive　intrathoracic anastomosis after Ivor Lewis esophagectomy for cancer：a review of transoral or transthoracic use of staplers. Surg Endosc， 2012， 26 （7）：1795-1802.
2. 　Hoppo T， Jobe BA， Hunter JG. Minimally invasive esophagectomy：the evolution and technique of minimally invasive surgery for esophageal cancer. World J Surg， 2011， 35 （7）：1454-1463.
3. 　Allen MS. Ivor Lewis esophagectomy. Semin Thorac Cardiovasc Surg， 1992， 4 （4）：320-323.
4. 　Bains MS. Ivor Lewis esophagectomy. Chest Surg Clin N Am， 1995， 5 （3）：515-526.
5. 　Marangoni G， Villa F， Shamil E， et al. OrVilTM-assisted anastomosis in laparoscopic upper gastrointestinal surgery：friend of the laparoscopic surgeon. Surg Endosc， 2012， 26 （3）：811-817.
6. 　Campos GM， Jablons D， Brown LM， et al. A safe and reproducible anastomotic technique for minimally invasive Ivor Lewis oesophagectomy：the circular-stapled anastomosis with the trans-oral anvil. Eur J Cardiothorac Surg， 2010， 37 （6）：1421-1426.
7. 　Jaroszewski DE， Williams DG， Fleischer DE， et al. An early experience using the technique of transoral OrVil EEA stapler for minimally invasive transthoracic esophagectomy. Ann Thorac Surg， 2011， 92 （5）：1862-1869.
8. 　Luketich JD， Pennathur A， Awais O， et al. Outcomes after minimally invasive esophagectomy：review of over 1000 patients. Ann Surg， 2012， 256 （1）：95-103.
9. 　Berger AC， Bloomenthal A， Weksler B， et al. Oncologic efficacy is not compromised， and may be improved with minimally invasive　esophagectomy. J Am Coll Surg， 2011， 212 （4）：560-566.
10. 　Li H， Hu B， You B， et al. Completely minimally invasive Ivor Lewis esophagectomy：the preliminary experience of circular-stapled anastomosis with the trans-oral anvil. Zhonghua Wai Ke Za Zhi， 2010， 48 （22）：1747-1750.
11. 　Ben-David K， Sarosi GA， Cendan JC， et al. Technique of minimally invasive Ivor Lewis esophagogastrectomy with intrathoracic stapled side-to-side anastomosis. J Gastrointest Surg， 2010， 14 （10）：1613-1618.
12. 　Bonavina L， Laface L， Abate E， et al. Comparison of ventilation and cardiovascular parameters between prone thoracoscopic and Ivor Lewis esophagectomy. Updates Surg， 2012， 64 （2）：81-85.
13. 　Bakhos CT， Fabian T， Oyasiji TO， et al. Impact of the surgical technique on pulmonary morbidity after esophagectomy. Ann Thorac Surg， 2012， 93 （1）：221-226.
14. 　Atkins BZ， Shah AS， Hutcheson KA， et al. Reducing hospital　morbidity and mortality following esophagectomy. Ann Thorac Surg， 2004， 78 （4）：1170 -1176 .
15. 　Pham TH， Perry KA， Dolan JP， et al. Comparison of perioperative outcomes after combined thoracoscopic-laparoscopic esophagectomy and open Ivor-Lewis esophagectomy. Am J Surg， 2010， 199 （5）：594-598.
16. 　Hamouda AH， Forshaw MJ， Tsigritis K， et al. Perioperative　outcomes after transition from conventional to minimally invasive Ivor-Lewis esophagectomy in a specialized center. Surg Endosc， 2010， 24 （4）：865-869.
17. 　Kinjo Y， Kurita N， Nakamura F， et al. Effectiveness of combined thoracoscopic-laparoscopic esophagectomy：comparison of postoperative complications and midterm oncological outcomes in patients with esophageal cancer. Surg Endosc， 2012， 26 （2）：381-390.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Early Experience of Combined Laparoscopic and Thoracoscopic Esophagectomy and Intrathoracic Esophagogastric Anastomosis

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