ObjectiveTo compare the short-term outcomes between Ivor Lewis esophagectomy and McKeown esophagectomy under thoracoscopy and laparoscopy for thoracic middle-lower esophageal carcinoma and to investigate the optimal approach.MethodsThe relevant literatures (from database foundation to March 2016) comparing minimally invasive Ivor Lewis esophagectomy and minimally invasive McKeown esophagectomy were searched through PubMed, EMbase, The Cochrane Library, CBM, CNKI, Wanfang Data and VIP. RevMan 5.3 software was used for data analysis.ResultsA total of 870 patients in 5 studies were reviewed and data were pooled for analysis. The score of Newcastle Ottawa for the literatures was 7-8 points. The results showed that compared with the McKeown group, Ivor Lewis group had shorter operation time (WMD=–34.67, 95% CI –53.70 to –15.65, P=0.000 4), less recurrent laryngeal nerve injuries (OR=0.23, 95% CI 0.12 to 0.44, P<0.000 01), anastomotic leakage (OR=0.24, 95% CI 0.14 to 0.41, P<0.000 01), anastomotic stenosis (OR=0.30, 95% CI 0.16 to 0.55, P=0.000 01), and pulmonary complications ( OR=0.25, 95% CI 0.15 to 0.43, P<0.000 01). There was no significant difference between the two groups in intraoperative blood loss, postoperative stay, hospitalization cost and chylothorax incidence. The McKeown group was associated with much more lymph nodes dissection (WMD=–1.16, 95% CI –2.00 to –0.31,P=0.007) than the Ivor Lewis group.ConclusionCompared with McKeown esophagectomy combined with thoracoscopy and laparoscopy, Ivor Lewis esophagectomy combined with thoracoscopy and laparoscopy has some advantages for thoracic middle-lower esophageal carcinoma, but a greater number of lymph nodes are dissected in McKeown procedure.
Objective To evaluate the security and outcomes of thoracolaparoscopic esophagectomy (TLE) versus open approach (OA) for thoracic esophageal squamous cell carcinoma. Methods From June 2014 to June 2015, 125 patients with thoracic esophageal squamous cell carcinoma underwent esophagectomy through McKeown approach, including TLE (a TLE group, 107 patients, 77 males and 30 females) and OA (an OA group, 18 patients, 13 males and 5 females). The data of operation and postoperative complications of the two groups were analyzed retrospectively. Results There was no statistical difference in the duration of operation and ICU stay and resected lymph nodes around laryngeal recurrent nerve between the TLE group and the OA group (333.58±72.84 min vs. 369.17±91.24 min, P=0.067; 2.84±1.44 d vs. 6.44±13.46 d, P=0.272; 4.71±3.87 vs. 3.89±3.97, P=0.408) . There was a statistical difference in blood loss, total resected lymph nodes and resected lymph nodes groups between TLE group and OA group (222.62±139.77 ml vs. 427.78±276.65, P=0.006; 19.62±9.61 vs. 14.61±8.07, P=0.038; 3.70±0.99 vs. 3.11±1.13, P=0.024). The rate of postoperative complications was 32.7% in the TLE group and 38.9% in the OA group (P=0.608). There was a statistical difference (P=0.011) in incidence of pulmonary infection (2.8% in the TLE group and 16.7% in the OA group). Incidences of complications, such as anastomotic leakage, cardiac complications, left-side hydrothorax, right-side pneumothorax, voice hoarse and incision infection, showed no statistical difference between two groups. Conclusion For patients with thoracic esophageal squamous cell carcinoma, TLE possesses advantages of more harvested lymph nodes, less blood loss and less pulmonary infection comparing with open approach, and is complied with the principles of security and oncological radicality of surgery.
Objective To evaluate the safety and efficacy of neoadjuvant therapy followed by minimally invasive esophagectomy (MIE) for locally advanced esophageal cancer. Methods We retrospectively analyzed clinical data of 56 consecutive patients with locally advanced esophageal cancer treated by neoadjuvant therapy followed by surgery in our hospital between January 2015 and December 2016. There were 51 males and 5 females. The patients were divided into 2 groups. Neoadjuvant therapy followed by open surgery esophagectomy group was as an OE group with 25 patients aged 61 (50-73) years. And neoadjuvant therapy followed by MIE was as a MIE group with 31 patients aged 60 (55-79) years. Results The pathologic complete response (pCR) rate of 28 patients with neoadjuvant concurrent chemoradiotherapy was significantly higher than that of 28 patients with neoadjuvant chemotherapy (21.4% vs. 10.7%, P<0.05). The operation time, intraoperative blood loss, R2 rate and the number of lymph nodes dissection in the MIE group were obviously better than those of the OE group with statistical differences (P<0.05). However, there was no significant difference in the number of resected lymph nodes along the bilateral recurrent laryngeal nerves and lymph node metastasis rate (P>0.05) between the two groups. The incidence of postoperative respiratory complications in the MIE group was lower than that of the OE group (P=0.041). There was no significant difference between the two groups in the incidence of other complications, re-operation, re-entry to ICU, median length of stay or perioperative deaths (P>0.05). There was only one patient with neoadjuvant concurrent chemoradiotherapy in the OE group died due to gastric fluid asphyxia caused by trachea-esophageal fistula. Conclusion Neoadjuvant therapy followed by MIE for locally advanced esophageal cancer is safe and feasible. The oncological outcomes seem comparable regardless of OE.
Objective To compare the short-term efficacy of Ivor-Lewis via hand-sewn purse-string approach and purse-string forceps approach in minimally invasive esophagectomy for middle and lower esophageal cancer, and to discuss the safety and feasibility of hand-sewn purse-string anastomosis technique for minimally invasive Ivor-Lewis esophagectomy (MIILE). Methods The clinical data of 151 patients undergoing thoracoscopic and laparoscopic esophageal cancer surgery from January 2014 to January 2017 in our hospital were retrospectively analyzed. According to the different methods of purse string making, the patients were divided into a purse-string forceps group including 49 males and 16 females with a mean age of 67.98±7.07 years ranging from 51 to 80 years treated with forceps to make purse-string and a handcraft group including 61 males and 25 females with a mean age of 67.76±8.18 years ranging from 52 to 83 years using hand-sewn way. The perioperative data of two two groups were compared. Results The purse-string making time and postoperative total volume of chest drainage were less in the handcraft group than those in the purse-string forceps group (P<0.05). There was no significant difference between the two groups in hemorrhage during operation, the operation duration or postoperative hospital stay (P>0.05). There was also no statistical difference between the two groups in the rate of anastomotic or gastric tube fistula, anastomotic stenosis, pulmonary infection or incision infection (P>0.05). Conclusion In minimally invasive esophagectomy for middle-lower section, MIILE by hand-sewn purse-string is as safe as purse-string forceps, with no more complications, needing no professional equipments, and easy to learn, master and promote.
In this review, development and application of the minimally invasive esophagectomy(MIE) for esophageal cancer are discussed including the types of MIE procedures, short- and long- term outcome after MIE; as well the future of MIE is forecasted. Main procedures of MIE performed currently include esophagectomy via thoracoscopy and laparoscopy and cervical esophagogastrosty, Ivor-Lewis MIE via thoracoscopy and laparoscopy, and hiatal MIE. Ivor-Lewis MIE gradually becomes a standard surgical option for the cancer of distal esophagus or esophagogastric junction while the solution of intrathoracic anastomosis via thoracoscopy has achieved. Several methods of intrathoracic anastomosis are reported such as hand-sewn, circular stapler, side-to-side and triangular anastomosis. MIE could decrease operative blood loss, shorten hospital stay and ICU stay, reduce postoperative especially pulmonary complications, and harvest more lymph nodes compared to open esophagectomy. The long-term survival has been proved similar with that after open esophagectomy for esophageal cancer. MIE has developed rapidly in recent years with some aspects in future prospectively: individual MIE treatment and quality of life, fast track after surgery, and robot-assisted MIE, as well the endoscopic submucosal dissection for esophageal cancer is mentioned.
Nowadays, thoracoscopic laparoscopic esophagectomy (TLE) has been widely used in the treatment of esophageal cancer. In recent years, robot assisted minimally invasive esophagectomy (RAMIE) has been developing vigorously. According to the research progress and practical experience in the world, RAMIE has the same safety and effectiveness as TLE. In this paper, several aspects on this novel operation were demonstrated, including the safety evaluation, lymph node dissection, prognosis of RAMIE, comparison of RAMIE and TLE, and the role of RAMIE in multidisciplinary treatment of esophageal cancer, in order to promote the rational application of RAMIE in esophagectomy.
ObjectiveTo investigate the learning curve of non-tube and early oral feeding procedure following McKeown minimally invasive esophagectomy (MIE). MethodsWe analyzed the clinical data of 38 patients (26 males, 12 females, aged 42–79 years) with esophageal cancer who received non-tube and early oral feeding procedure after surgery at the Affiliated Tumor Hospital, Zhengzhou University from November 2017 to August 2018. They suffered upper thoracic esophageal cancer (n=4), middle thoracic esophageal cancer (n=22) or lower thoracic esophageal cancer (n=12). ResultsMcKeown MIE was successfully performed on 38 patients. Oral feeding began 1.7 (1-4) days after surgery in the 38 patients with non-tube. Pneumonia/atelectasis occurred in 5 patients (13.1%), respiratory failure in 1 patient (2.6%), arrhythmia in 3 patients (7.9%), hoarseness in 5 patients (13.1%), anastomotic fistula in 1 patient (2.6%), cervical incision infection in 1 patient (2.6%), pneumomediastinum and infection in 1 patient (2.6%) and gastric emptying disorder in 2 patients (5.2%). No death was observed. After 26 patients with McKeown MIE were treated with enhanced recovery after surgery procedure, the operation time and complications could reach a relatively stable state and entered a plateau phase of learning curve. ConclusionNon-tube and early oral feeding procedure following MIE is technically safe and feasible. It can shorten hospital stay, relieve the discomfort of placement of nasogastric and nutrition tube and may reduce the incidence of complications. The learning curve of non-tube and early oral feeding procedure following MIE is about 26 cases.
ObjectiveTo evaluate the safety, feasibility and short-term outcomes of single-direction gastric mobilization under 3D-laparoscopy in minimally invasive esophagectomy for the treatment of esophageal cancer.MethodsFrom February 2018 to December 2019, 118 consecutive patients who underwent minimally invasive McKeown esophagectomy for esophageal squamous cell carcinoma in our hospital were included. There were 94 males and 24 females with an average age of 53.7 (41–77) years. They were divided into two groups based on the methods of gastric mobilization: a traditional dissociation (TD) group (n=55) and a single-direction mobilization (MD) group (n=63). The clinical data of the two groups were compared.ResultsEnbloc resection and a negative resection margin were obtained in all patients. There was no postoperative mortality or incision complication. The rate of postoperative complications was 22.9%. There was no significant difference in the spleen injury, gastric injury, conversion to open surgery, abdominal reoperation as well as cervical anastomotic leakage between the two groups (P>0.05). It took significantly less time in the MD group compared with the TD group (P<0.05). There was an obvious statistical difference in the incidence of gastric mobilization related complications between the MD group (1.6%, 1/63) and TD group (12.7%, 7/55, P<0.05).ConclusionApplication of single-direction gastric mobilization under 3D-laparoscopy in minimally invasive esophagectomy for the treatment of esophageal cancer is safe and easy to perform with a satisfactory short-term outcome.
ObjectiveTo explore the safety and feasibility of the modified and improved thoracoscopic surgery for esophageal cancer using the concept of "single-direction" thoracoscopic technique.MethodsThe clinical data of 65 patients undergoing this modified minimally invasive esophagectomy based on "single-direction" thoracoscopic system between June 2018 and April 2019 were retrospectively analyzed, including 54 males and 11 females aged 62.5±7.8 years.ResultsThe thoracoscopic operation time was 133.4±28.6 min, and intraoperative blood loss was 61.9±29.2 mL. No intraoperative blood transfusion was needed. One patient was transferred to open thoracotomy (due to severe pleural adhesion atresia). Major complications included anastomotic leak, pneumonia, chylothorax, incisional infection, recurrent laryngeal nerve paralysis and gastric emptying disorders, which were recovered by conservative treatment. No postoperative death occurred. The median number of lymph nodes and lymph node station harvested was 19 and 10, respectively. The median postoperative hospital stay was 10 days. The volume of chest drainage was 1 117.3±543.4 mL.ConclusionThe minimally invasive operation mode of esophageal cancer based on "single-direction" thoracoscopic system is safe and feasible, and has good field vision and smooth and simplified procedure.
ObjectiveTo compare the surgical efficacy of Da Vinci robot-assisted minimally invasive esophagectomy (RAMIE) and video-assisted minimally invasive esophagectomy (VAMIE) on esophageal cancer.MethodsOnline databases including PubMed, the Cochrane Library, Medline, EMbase and CNKI from inception to 31, December 2019 were searched by two researchers independently to collect the literature comparing the clinical efficacy of RAMIE and VAMIE on esophageal cancer. Newcastle-Ottawa Scale was used to assess quality of the literature. The meta-analysis was performed by RevMan 5.3.ResultsA total of 14 studies with 1 160 patients were enrolled in the final study, and 12 studies were of high quality. RAMIE did not significantly prolong total operative time (P=0.20). No statistical difference was observed in the thoracic surgical time through the McKeown surgical approach (MD=3.35, 95%CI –3.93 to 10.62, P=0.37) or in surgical blood loss between RAMIE and VAMIE (MD=–9.48, 95%CI –27.91 to 8.95, P=0.31). While the RAMIE could dissect more lymph nodes in total and more lymph nodes along the left recurrent laryngeal recurrent nerve (MD=2.24, 95%CI 1.09 to 3.39, P=0.000 1; MD=0.89, 95%CI 0.13 to 1.65, P=0.02) and had a lower incidence of vocal cord paralysis (RR=0.70, 95%CI 0.53 to 0.92, P=0.009).ConclusionThere is no statistical difference observed between RAMIE and VAMIE in surgical time and blood loss. RAMIE can harvest more lymph nodes than VAMIE, especially left laryngeal nerve lymph nodes. RAMIE shows a better performance in reducing the left laryngeal nerve injury and a lower rate of vocal cord paralysis compared with VAMIE.