Thoracoscopic esophagectomy with total meso-esophageal excision reduces regional lymph node recurrence
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We investigated the operative outcomes of thoracoscopic esophagectomy (TE) in the prone position, using the concept of total meso-esophageal excision for esophageal cancer.
The medical records of 140 consecutive patients with esophageal cancer who underwent radical esophagectomy by TE were reviewed retrospectively, and operative outcomes were compared between patients treated before (non-meso-esophagus; non-ME group) and after (ME group) the introduction of total meso-esophageal excision (ME).
There were no significant differences between the groups in postoperative morbidity (non-ME group vs. ME group, 28.3% vs. 41.4%, p = 0.119), 30-day mortality (non-ME group vs. ME group, 0% vs. 1.1%; p = 0.433), and in-hospital mortality (non-ME group vs. ME group, 1.9% vs. 0%, p = 0.199). Although overall survival and relapse-free survival did not differ significantly between the groups, the overall recurrence rate was significantly lower in the ME group than the non-ME group (non-ME group vs. ME group, 43.4% vs. 23%, p = 0.011). In particular, the rate of regional lymph node recurrence in the mediastinum was lower in the ME group (non-ME group vs. ME group, 11.3% vs. 2.3%; p = 0.026).
Our results suggest that the ME procedure might be one of the procedures that reduce regional lymph node recurrence in the mediastinum without any deterioration in short-term outcomes.
KeywordsThoracoscopic esophagectomy Minimally invasive esophagectomy Esophageal cancer Meso-esophagus Preceding anterior approach
Study conception and design: Yuji Akiyama and Takeshi Iwaya. Acquisition of data: Fumitaka Endo, Haruka Nikai, Kei Sato, Shigeaki Baba, and Takehiro Chiba. Analysis and interpretation of data: Toshimoto Kimura, Takeshi Takahara, Koki Otsuka, and Hiroyuki Nitta. Drafting of manuscript: Yuji Akiyama and Takeshi Iwaya. Critical revision of manuscript: Masaru Mizuno, Yusuke Kimura, Keisuke Koeda, and Akira Sasaki.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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