ObjectiveTo investigate the short-term follow-up results of inflatable mediastinoscopy combined with laparoscopy in the treatment of esophageal cancer.MethodsClinical data of 102 patients with esophageal cancer who underwent minimally invasive esophagectomy were enrolled in our hospital from January 2017 to January 2019. Patients were divided into two groups according to different surgical methods, including a single-port inflatable mediastinoscopy combined with laparoscopy group (group A, n=59, 53 males and 6 females, aged 63.3±7.6 years, ranging from 45 to 75 years) and a video-assisted thoracoscopy combined with laparoscopy group (group B, n=43, 35 males and 8 females, aged 66.7±6.7 years, ranging from 50-82 years). The short-term follow-up results of the two groups were compared.ResultsCompared with the group A, the rate of postoperative pulmonary complication of the group B was significantly lower (18.64% vs. 4.65%, P<0.05). There was no significant difference between the two groups in other postoperative complications (P>0.05). The 6-month, 1-year, and 2-year survival rates were 96.61%, 89.83%, and 73.33%, respectively in the group A, and were 95.35%, 93.02%, and 79.17%, respectively in the group B. There was no significant difference in short-term survival rate after operation (P>0.05).ConclusionIn the treatment of esophageal cancer, the incidence of pulmonary complications of inflatable mediastinoscopy combined with laparoscopy is lower than that of traditional video-assisted thoracoscopy combined with laparoscopy, and there is no significant difference in other postoperative complications or short-term survival rate between the two methods. Inflatable mediastinoscopy combined with laparoscopy for radical esophageal cancer is a relatively safe surgical method with good short-term curative effects, and long-term curative effects need to be further tested.
ObjectiveTo compare the efficacy of mediastinoscope-assisted transhiatal esophagectomy (MATHE) and functional minimally invasive esophagectomy (FMIE) for esophageal cancer. MethodsPatients 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. ResultsA 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). ConclusionCompared 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.
ObjectiveTo explore the application effects of hand-sewn layered anastomosis (HS) and circular stapled anastomosis (CS) in inflatable mediastinal mirror synchronous laparoscopic radical esophagectomy for esophageal cancer. MethodsPatients who underwent inflatable mediastinal mirror synchronous laparoscopic radical esophagectomy for esophageal cancer in Huaihe Hospital of Henan University from 2018 to 2019 were retrospectively included. Patients were divided into a HS group and a CS group according to the anastomosis methods, and propensity score matching was used to match patients at a ratio of 1:1. The baseline clinical characteristics, perioperative indicators, CD4+/CD8+ immune index comparison, pain, various lung function indicators, incidence of short-term and long-term postoperative complications, and quality of life were compared between the two groups. ResultsA total of 153 patients were included, including 108 males and 45 females, with an average age of (61.81±5.18) years. After propensity score matching, 70 patients were included in each group. Compared with the CS group, the operation time was longer in the HS group [(107.10±8.25) min vs. (97.65±6.85) min, P<0.001]; the CD4+/CD8+ level was lower in the HS group 1-3 days after surgery; the pain score was higher, and various lung function indicators (forced expiratory volume in the first second, forced vital capacity, and one-second rate) were lower in the HS group 1-7 days after surgery; within 6 months after surgery, the incidence of anastomosis-related complications (anastomotic stenosis, anastomotic fistula, and gastroesophageal reflux) was lower in the HS group; and the quality of life score was higher in the HS group from 14 days to 6 months after surgery (P<0.05). ConclusionHS can reduce the incidence of postoperative anastomotic fistula, anastomotic stenosis, and gastroesophageal reflux, and improve the short-term quality of life of patients, but it has a longer operation time, more intense short-term postoperative pain, and may affect the early recovery of lung function. HS and CS are complementary, and the appropriate surgical method should be chosen according to the individual situation of the patient to achieve the maximum clinical benefit.
With the widespread application of minimally invasive esophagectomy, inflatable video-assisted mediastinoscopic transhiatal esophagectomy (IVMTE) has gradually become one of the alternative surgical methods for transthoracic esophagectomy due to less trama, fewer perioperative complications and better short-term efficacy. However, there is no uniform standard for surgical methods and lymph node dissection in medical centers that perform IVMTE, which affects the standardization and further promotion of IVMTE. Therefore, on the basis of fully consulting domestic and foreign literature, our team proposed an expert consensus focusing on IVMTE, in order to standardize the clinical practice, guarantee the quality of treatment and promote the development of IMVTE.
Objective To evaluate the clinical role of video-assisted mediastinoscopy and its safety and effectiveness in the diagnosis of thoracic disease. Methods We reviewed the clinical data of consecutive 40 patients (25 males and 15 females with an average age of 54.6 years) who received video-assisted mediastinoscopic surgery in our department of thoracic surgery from December 2011 to November 2016, including mediastinal lymph node biopsy in 27 patients, mediastinal primary lesions biopsy in 8, bronchial cystectomy in 3 and esophageal dissection in 2. Results The histological results were positive in 20 patients (73.1%) in mediastinal lymph node biopsy, including granulomatous mediastinitis in 14 and metastasis in 6 (non-small cell lung cancer in 4, Ewing sacoma in 1 and small cell lung cancer in 1) and reactive proliferation in 7 (26.9%). In mediastinal primary lesions biopsy, the accuracy rate of diagnosis was 100.0%. The pathologic results were malignant in all patients, including small cell lung cancer in 5, adenoid cystic carcinoma in 1, squamous carcinoma in 1 and adenocarcinoma in 1. In patients who received the bronchial cystectomy, no recurrence was found during at least 2 years follow-up. There was one patient with severe complication (innominate artery injury). Two patients suffered transient laryngeal recurrent nerve palsy with hoarseness and two patients incision secretion. Conclusion Video-assisted mediastinoscopic surgery is effective and safe and dissection should be careful in granulomatous mediastinitis to avoid the great vessel injures.
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 investigate the feasibility, safety, and effectivity of the application of systematic lymph node dissection (SLND) in inflatable video-assisted mediastinoscopic transhiatal esophagectomy (IVMTE). MethodsThe clinical data of the patients who underwent IVMTE for esophageal cancer in the First Affiliated Hospital of University of Science and Technology of China From January to October 2024 were restrospectively analyzed. They were divided into a SLND group and an elective lymph node dissection (ELND) group according to intraoperative lymph node resection. clinical characteristics and perioperative outcomes were compared between the two groups. Results A total of 66 patients were enrolled, including 51 males and 15 females, with a mean age of (70.13 ± 8.49) years. There were 12 patients in the selective lymph node dissection (SLND) group and 54 patients in the extended lymph node dissection (ELND) group. There were no statistical differences between the two groups in terms of age, sex, cT stage, tumor location, differentiation grade, pT stage, pN stage, and preoperative comorbidities (P>0.05). statistical differences were observed between the two groups in terms of receiving preoperative neoadjuvant therapy and pTNM staging (P<0.05). There were no statistical differences between the two groups in postoperative complications, operative time, intraoperative blood loss, postoperative hospital stay, and left recurrent laryngeal nerve paratracheal lymph node dissection (P>0.05). The SLND group had a higher average number of lymph nodes dissected, number of stations, number of mediastinal lymph nodes, and number of mediastinal stations than the ELND group. statistical differences were observed between the two groups in the dissection of paraesophageal, right recurrent laryngeal nerve, subcarinal, and diaphragmatic lymph nodes (P<0.05). There were no statistical differences between the two groups in mediastinal lymph node metastasis and cervical lymph node metastasis (P>0.05). The SLND group had more abdominal lymph node metastasis than the ELND group, and the difference was statistically significant (P=0.034). Univariate and multivariate logistic regression analysis showed that cervical lymph node dissection was a risk factor for postoperative complications (P=0.023). Conclusion SLND is safe and effective in IVMTE. Compared with the ELND group, it increased the number of lymph nodes and stations dissected in the mediastinum, and improved the accuracy of postoperative staging. Meanwhile, it did not prolong operative time or hospital stay, nor did it increase the risk of postoperative complications or non-surgical complications.