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Single-Port Inflatable Mediastinoscopy Combined With Laparoscopic-Assisted Small Incision Surgery for Radical Esophagectomy Is an Effective and Safe Treatment for Esophageal Cancer

  • Xiaojin Wang
  • Xiaojian Li
  • Hua Cheng
  • Bin Zhang
  • Hongcheng Zhong
  • Ruiqi Wang
  • Beilong Zhong
  • Qingdong CaoEmail author
Original Article
  • 35 Downloads

Abstract

Background

We previously developed a novel non-trans thoracic esophagectomy, the single-port inflatable mediastinoscopy combined with laparoscopy for the radical esophagectomy of esophageal cancer. The purpose of this study was to report its therapeutic efficacy and safety.

Methods

From May 2016 to August 2017, we have completed 80 cases of radical resection of esophageal carcinoma using this novel surgical technique. The intraoperative findings and postoperative complications were reported.

Results

The operation was successfully performed in all patients except for one patient switched from laparoscopic-assisted operation to open surgery. The mean operation duration was 191.4 ± 27 min, and the mean intraoperative blood loss was 147.3 ± 28.9 mL. The mean number of removed lymph node was 21.9 ± 4.1. Five patients (6.4%) who had preoperative type I respiratory failure needed to stay in the intensive care unit for 24 h postoperatively. Postoperative complications included anastomotic leakage (8.9%), anastomotic stricture (21.25%), pleural effusion (9%), and hoarseness postoperative hoarseness (18.8%). The incidence of hoarseness at 3 months postoperation was reduced to 3.8%. All the complications were Clavien-Dindo grades I–III. There were no perioperative death and postoperative cardiopulmonary complications.

Conclusion

These results showed that the single-port inflatable mediastinoscopy combined with laparoscopy is feasible for radical esophagectomy and possesses good therapeutic efficacy and safety.

Keywords

Esophageal cancer Esophagectomy Non-thoracotomy Inflatable mediastinoscopy Laparoscopy 

Notes

Funding

This study was supported by the Talents start-up funding of Sun Yat-sen University.

Compliance with Ethical Standards

Conflicts of Interest

The authors declare that there are no conflicts of interest.

References

  1. 1.
    Napier KJ, Scheerer M, Misra S. Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities. World J Gastrointest Oncol 2014;6:112–120.CrossRefGoogle Scholar
  2. 2.
    Pakzad R, Mohammadian-Hafshejani A, Khosravi B, Soltani S, Pakzad I, Mohammadian M, Salehiniya H, Momenimovahed Z. The incidence and mortality of esophageal cancer and their relationship to development in Asia. Ann Transl Med 2016;4:29.CrossRefGoogle Scholar
  3. 3.
    Chen W, Zheng R, Zuo T, Zeng H, Zhang S, He J. National cancer incidence and mortality in China, 2012. Chin J Cancer Res 2016;28:1–11.CrossRefGoogle Scholar
  4. 4.
    Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:E359–E386.CrossRefGoogle Scholar
  5. 5.
    Pennathur A, Gibson MK, Jobe BA, Luketich JD. Oesophageal carcinoma. Lancet 2013;381:400–412.CrossRefGoogle Scholar
  6. 6.
    Sacak B, Orfaniotis G, Nicoli F, Liu EW, Ciudad P, Chen SH, Chen HC. Back-up procedures following complicated gastric pull-up procedure for esophageal reconstruction: Salvage with intestinal flaps. Microsurgery 2016;36:567–572.CrossRefGoogle Scholar
  7. 7.
    Luketich JD, Pennathur A, Awais O, Levy RM, Keeley S, Shende M, Christie NA, Weksler B, Landreneau RJ, Abbas G, Schuchert MJ, Nason KS. Outcomes after minimally invasive esophagectomy: Review of over 1000 patients. Ann Surg 2012;256:95–103.CrossRefGoogle Scholar
  8. 8.
    Biere SS, van Berge Henegouwen MI, Maas KW, Bonavina L, Rosman C, Garcia JR, Gisbertz SS, Klinkenbijl JH, Hollmann MW, de Lange ES, Bonjer HJ, van der Peet DL, Cuesta MA. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 2012;379:1887–1892.CrossRefGoogle Scholar
  9. 9.
    Canet J, Gallart L, Gomar C, Paluzie G, Vallès J, Castillo J, Sabaté S, Mazo V, Briones Z, Sanchis J; ARISCAT Group. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology 2010;113:1338–1350.CrossRefGoogle Scholar
  10. 10.
    Sengupta S. Post-operative pulmonary complications after thoracotomy. Indian J Anaesth 2015;59:618–626.CrossRefGoogle Scholar
  11. 11.
    Donohoe CL, O’Farrell NJ, Ravi N, Reynolds JV. Evidence-based selective application of transhiatal esophagectomy in a high-volume esophageal center. World J Surg 2012;36:98–103.CrossRefGoogle Scholar
  12. 12.
    Fujiwara H, Shiozaki A, Konishi H, Kosuga T, Komatsu S, Ichikawa D, Okamoto K, Otsuji E. Single-Port Mediastinoscopic Lymphadenectomy Along the Left Recurrent Laryngeal Nerve. Ann Thorac Surg 2015;100:1115–1117.CrossRefGoogle Scholar
  13. 13.
    Fujiwara H, Shiozaki A, Konishi H, Komatsu S, Kubota T, Ichikawa D, Okamoto K, Morimura R, Murayama Y, Kuriu Y, Ikoma H, Nakanishi M, Sakakura C, Otsuji E. Hand-assisted laparoscopic transhiatal esophagectomy with a systematic procedure for en bloc infracarinal lymph node dissection. Dis Esophagus 2016;29:131–138.CrossRefGoogle Scholar
  14. 14.
    Li GS. Prof. Qingdong Cao: single-port inflatable mediastinoscopy combined with laparoscopy for the radical treatment of esophageal cancer. J Thorac Dis 2016;8:E1108–E1109.CrossRefGoogle Scholar
  15. 15.
    Kanekiyo S, Takeda S, Tsutsui M, Nishiyama M, Kitahara M, Shindo Y, okumitsu Y, Tomochika S, Tokuhisa Y, Iida M, Sakamoto K, Suzuki N, Yamamoto S, Yoshino S, Hazama S, Ueno T, Nagano H. Low invasiveness of thoracoscopic esophagectomy in the prone position for esophageal cancer: a propensity score-matched comparison of operative approaches between thoracoscopic and open esophagectomy. Surg Endosc 2018;32:1945–1953.CrossRefGoogle Scholar
  16. 16.
    Yamashita K, Watanabe M, Mine S, Toihata T, Fukudome I, Okamura A, Yuda M, Hayami M, Ishizuka N, Imamura Y. Minimally invasive esophagectomy attenuates the postoperative inflammatory response and improves survival compared with open esophagectomy in patients with esophageal cancer: a propensity score matched analysis. Surg Endosc 2018 Apr 11. doi: https://doi.org/10.1007/s00464-018-6187-z.[Epubaheadofprint]Google Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Xiaojin Wang
    • 1
  • Xiaojian Li
    • 1
  • Hua Cheng
    • 1
  • Bin Zhang
    • 1
  • Hongcheng Zhong
    • 1
  • Ruiqi Wang
    • 1
  • Beilong Zhong
    • 1
  • Qingdong Cao
    • 1
    Email author
  1. 1.Department of Cardiothoracic SurgeryThe Fifth Affiliated Hospital of Sun Yat-sen UniversityZhuhaiChina

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