ObjectiveTo compare the safety and comfort of patients with or without postoperative gastric tube placement after esophageal cancer surgery, and analyze the cost and nursing time of gastric tube placement. Methods The patients with esophageal cancer undergoing minimally invasive surgery in West China Hospital of Sichuan University in 2021 were enrolled. The patients were divided into a gastric tube indwelling group and a non gastric tube indwelling group according to whether the gastric tube was indwelled after the operation. The safety and comfort indicators of the two groups were compared. Results A total of 130 patients were enrolled. There were 66 patients in the gastric tube indwelling group, including 53 males and 13 females, aged 61.80±9.05 years and 64 patients in the non gastric tube indwelling group, including 55 males and 9 females, aged 64.47±8.00 years. Six patients in the non gastric tube indwelling group needed to place gastric tube 1 to 3 days after the operation due to their condition. There was no statistical difference in the incidence of postoperative complications between the two groups (P>0.05). The subjective comfort of patients in the gastric tube indwelling group was significantly lower than that in the non gastric tube indwelling group (P<0.001), and the incidence of foreign body sensation in the throat of patients in the gastric tube indwelling group was higher than that in the non gastric tube indwelling group (P<0.001). The average nursing time in the gastric tube indwelling group was about 59.58 minutes, and the average cost of gastric tube materials and nursing was 378.24 yuan per patient. Conclusion No gastric tube used after operation for appropriate esophageal cancer patients will not increase the incidence of postoperative complications (pulmonary infection, anastomotic leakage, chylothorax), but can increase the comfort of patients, save cost and reduce nursing workload, which is safe, feasible and economical.
ObjectiveTo compare the short-and mid-term outcomes of patients with esophageal cancer after subtotal esophagectomy via thoracoscopy in lateral prone position, prone position, or left lateral position. MethodsThis randomized prospectively controlled study was conducted in 121 patients receiving subtotal esophagectomy via thoracoscopy between January 2010 and February 2013. The patients were randomly assigned into three groups to underwent esophagectomy in lateral prone position, prone position, or left lateral position, respectively. Forty-three patients (24 males, 19 females, 61.5±1.5 years) underwent surgery in lateral prone position, 39 patients (21 males, 18 females, 63.2±1.7 years) in prone position and other 39 patients (22 males, 17 females, 60.1±1.6 years) in left lateral position. Esophagogastric anastomosis was performed in the left neck. ResultsThe median operative time in the three groups was 232 (165-296) min, 230 (170-310) min, and 280 (190-380) min, respectively (P < 0.05). The median perioperative bleeding was 262 (185-330) ml, 275 (100-320) ml and 350 (120-560) ml, respectively (P > 0.05). The average number of harvested lymph nodes was 19.1 (9-26), 18.4 (11-23), 10.9 (6-21), respectively (P < 0.05). The postoperative medical complications occurred in 10, 9 and 11 patients in three groups, respectively, with no statistical difference. Twenty patients died in the lateral prone position group after a median follow-up period of 19.2 (6-31) months, 18 patients died in the prone position group after a median follow-up period of 20.7 (8-29) months, and 21 patients died in the left lateral position group after a median follow-up period of 18.5 (12-33) months. ConclusionThe results confirm the feasibility and safety of this minimally invasive esophagectomy via thoracoscopy in lateral prone position, prone position, or left lateral position for patients with esophageal carcinoma. A possible advantage of lateral prone technique is that in case of an emergency, precious time could be saved in changing the position of the patient.
ObjectiveTo compare the short-term outcomes of Da Vinci robot-assisted minimally invasive esophagectomy (RAMIE) and video-assisted thoracoscopic-laparoscopic minimally invasive esophagectomy (VAMIE) for esophageal cancer. MethodsA retrospective analysis was conducted on the data of patients with esophageal cancer admitted to Gansu Provincial People's Hospital from January 2021 to February 2025. Based on the surgical method, patients were divided into a RAMIE group and a VAMIE group. Both groups underwent standard McKeown three-incision surgery and systematic three-field lymph node dissection. Intraoperative blood loss, number of lymph nodes dissected, postoperative recovery indicators, and complication rates were compared. ResultsA total of 126 patients with esophageal cancer were included, of which 109 were male and 17 were female, with an average age of (64.6±8.8) years. The RAMIE group consisted of 36 patients and the VAMIE group 90 patients. There was no statistical difference in baseline indicators such as age, sex, and body mass index between the two groups (P>0.05). The difference in operation time between the two groups was not statistically significant [305.0 (280.0, 348.0) min vs. 300.0 (268.8, 340.0) min, P=0.457]. Compared with the VAMIE group, the RAMIE group had less intraoperative blood loss [100.0 (100.0, 120.0) mL vs. 100.0 (100.0, 200.0) mL, P=0.035], more intraoperative fluid infusion [(2244.7±610.3) mL vs. (1954.4±457.9) mL, P=0.013], a higher number of lymph nodes dissected [(27.9±10.6) nodes vs. (21.3±5.1) nodes, P<0.001], and the difference in the number of lymph node dissection groups was not statistically significant [8.0 (6.0, 8.0) groups vs. 7.0 (5.0, 8.0) groups, P=0.268]. In terms of postoperative recovery indicators, compared with the VAMIE group, the RAMIE group had shorter postoperative hospital stay [12.5 (9.0, 18.0) d vs. 17.0 (14.0, 22.0) d, P＜0.001] and shorter time with tubes [9.0 (8.0, 10.0) d vs. 10.0 (9.0, 12.0) d, P=0.007]. In terms of postoperative complications, the incidence of recurrent laryngeal nerve injury in the RAMIE group was significantly lower than that in the VAMIE group (2.8% vs. 16.7%, P=0.039), there was no statistical difference in pulmonary infection, anastomosis leakage, and incision infection between the two groups (P>0.05). The total hospitalization cost of the RAMIE group was significantly higher than that of the VAMIE group (P<0.001). ConclusionRAMIE has significant advantages over VAMIE in terms of intraoperative bleeding control, the number of lymph node dissections, postoperative recovery speed, and reducing the risk of incision infection and recurrent laryngeal nerve injury, with good safety and feasibility.
ObjectiveTo compare the clinical efficacy of cone-shaped gastric tube combined with cervical end-to-end stratified manual anastomosis and conventional tubular stomach combined with neck end-to-end mechanical side-to-side anastomosis in thoracoscopic and laparoscopic esophagectomy for esophageal cancer. MethodsThe clinical data of consecutive patients treated by thoracoscopic and laparoscopic esophagectomy for esophageal cancer in the Department of Cardiothoracic Surgery of the First People's Hospital of Neijiang from January 1, 2018 to March 25, 2021 were analyzed. The patients were divided into a cone-shaped gastric tube manual group (treated with cone-shaped gastric tube combined with cervical end-to-end stratified manual anastomosis) and a conventional tubular stomach mechanical group (treated with conventional tubular stomach+end-to-end mechanical side-to-side anastomosis). The anastomotic time, intraoperative blood loss, number of lymph node dissection, anastomotic fistula, anastomotic stenosis, anastomotic cost, sternogastric dilatation, gastroesophageal reflux symptoms, and postoperative complications were compared and analyzed between the two groups. ResultsA total of 161 patients were enrolled, including 112 males and 49 females aged 40-82 years. There were 80 patients in the cone-shaped gastric tube manual group, and 81 patients in the conventional tubular stomach mechanical group. There was no statistical difference in the intraoperative blood loss, number of lymph nodes dissected, hoarseness, pulmonary infection, arrhythmia, respiratory failure or chylothorax between the two groups (P>0.05). The anastomosis time of the cone-shaped gastric tube manual group was longer than that of the conventional tubular stomach mechanical group (28.35±3.20 min vs. 14.30±1.26 min, P<0.001), but the anastomotic cost and incidence of thoracogastric dilatation in the cone-shaped gastric tube manual group were significantly lower than those of the conventional tubular stomach mechanical group [948.48±70.55 yuan vs. 4 978.76±650.29 yuan, P<0.001; 3 (3.8%) vs. 14 (17.3%), P=0.005]. The incidences of anastomotic fistula and anastomotic stenosis in the cone-shaped gastric tube manual group were lower than those in the conventional tubular gastric mechanical group, but the differences were not statistically significant (P>0.05). The gastroesophageal reflux scores in the cone-shaped gastric tube manual group were lower than those in the conventional tubular gastric mechanical group at 1 month, 3 months, 6 months and 1 year after the operation (P<0.05). Logistic regression analysis showed that digestive tract reconstruction method was the influencing factor for postoperative thoracogastric dilation, which was reduced in the cone-shaped gastric tube manual group. ConclusionCone-shaped gastric tube combined with cervical end-to-end stratified manual anastomosis can significantly reduce the incidence of thoracogastric dilatation after thoracoscopic and laparoscopic esophagectomy for esophageal cancer and save hospitalization costs, with mild gastroesophageal reflux symptoms, and it still has certain advantages in reducing postoperative anastomotic fistula and anastomotic stenosis, which is worthy of clinical promotion.