Comparison of Short-term Outcome of Thoracoscopic-Laparoscopic Esophagectomy Versus Transhiatal Esophagectomy for Resectable Esophageal Cancer

Background: Esophagectomy is performed in all patients with resectable esophageal cancer. Transthoracic-Laparoscopic Esophagectomy (TLE) is a minimally invasive method and considered to be the most appropriate method. In this study, we aim to evaluate and compare the perioperative outcome, and 1-year overall survival of TLE and Transhiatal Esophagectomy (THE) approaches. Methods: In this retrospective study, we reviewed the medical records of 108 patients with esophageal cancer undergoing TLE (n=44) or THE (n=64) between 2015 and 2018. The patients were followed for one year. The intraoperative and postoperative findings, as well as 1-year overall-survival, were compared between the two groups. Results: TLE compared to THE had a longer surgery duration (278.63±33.28 vs 223.28±33.99 min, P=0.001), a higher number of dissected lymph nodes (15.06±2.95 vs 10.21±2.58, P=0.001), less blood loss (345.45±178.76 vs 585.15±294.75 mL, P<0.001), and need for transfusion (20.5% vs 45.3%, P=0.006) during surgery as well as lower ICU stay (2.59±0.77 vs 3.90±0.83 days, P<0.001) and ward stay (8.77±0.96 vs 11.42±1.71 days, P<0.001). THE had somewhat higher complication than TLE, but with no significant differences. Conclusion: TLE had a similar rate of complication to THE approach, but with lower blood loss and lower ICU and hospital stay, it is a more appropriate method for esophagectomy.

Feasibility and effectiveness of multi-injection thoracic paravertebral block via the intrathoracic approach for analgesia after thoracoscopic-laparoscopic esophagectomy

Background We observed the feasibility and effectiveness of multi-injection thoracic paravertebral block (TPB) via the intrathoracic approach under thoracoscopic direct vision for analgesia after thoracoscopic-laparoscopic esophagectomy (TLE). Methods Sixty patients undergoing TLE were randomly divided into a control group and an observation group. All patients underwent TPB via the intrathoracic approach at the three levels of T2, 5, and 8 with a scalp needle before closing the chest. The patients in the observation group received 10 ml 0.375% ropivacaine at each level, and the patients in the control group received 10 ml of 0.9% saline at each level. A patient-controlled intravenous analgesic (PCIA) pump with sufentanil was attached to all patients after surgery. The sufentanil consumption, number of PCIA presses and use of rescue analgesia in the first 24 h after surgery were recorded. The visual analogue scale (VAS) scores (rest and coughing) were recorded at 2 h, 6 h, 12 h, 24 h, and 48 h after surgery. The duration of postoperative hospital stay, active cough rate, first ambulation, and the incidence of adverse reactions after surgery was recorded. Results The sufentanil consumption in the observation group was significantly lower than that in the control group (34.7 ± 1.9 µg vs. 52.1 ± 2.1 µg; P < 0.001). The VAS score at each postoperative time point, number of PCIA presses, use of rescue analgesia, and the incidence of adverse reactions in the observation group were significantly lower than those in the control group. The postoperative active cough rate of patients in the observation group was significantly higher than those in the control group, and the times of the first ambulation after surgery and postoperative hospital stay in the observation group were significantly shorter than those in the control group (all P < 0.05). Conclusions Multi-injection TPB via the intrathoracic approach under thoracoscopic direct vision is easy to perform and can effectively alleviate postoperative pain after TLE with fewer adverse reactions and contributing to improved postoperative recovery.

Phẫu thuật nội soi ngực bụng trong điều trị ung thư thực quản

Objectives: Evaluating the results of thoraco-laparoscopic esophagectomy to treat esophageal cancer, prospective studies of 35 patients esophageal cancer were conducted from January 2016 to December 2019 at Hue Central Hospital. Results: Average age 57.6±6.3years (44-69), male/female 16.5/1. Clinical symptoms: 82.9% swallowing difficulty, weight loss 34.3%, increased preoperative CEA 31.4%, mean tumor size 2.6±1.2cm(3-6). Stage: I 31.4%; II 45.7%; III of 22.9%. Time of surgery 315.2±49.9minutes(240-420), mean hospital stay 15.6±7.2days(7-25). Postoperative complications: pneumonia 11.4% , leakage of neck anastomosis 8.6%, hoarseness 11.4% and mortality 2.9%. Follow-up time 2-35months, anastomotic recurrence 2.9%, local recurrence 5.9% and metastasis 8.8%. The overal survival time 28.4±1.9months, the survival time after 12 months 84.7% and after 2 years 73.9%. Conclusion: Thoraco-laparoscopic esophagectomy to treat esophageal cancer has many advantages, avoiding to the long thoracotomy-laparotomy, reducing postoperative pain, reducing respiratory complications during the postoperative period. However, a larger number of patients should be studied to accurately evaluate long-term results, especially in oncology results.

Evaluating early results of minimally invasive esophagectomy in abdominal surgery department II at National K Hospital

Introduction: To evaluate early results of minimally invasive esophagectomy for esophageal cancer in Abdominal Surgery Department II at National K Hospital. Materials and methods: 130 patients with esophageal cancer underwent thoraco-laparoscopic esophagectomy - also was known as minimally invasive esophagectomy (MIE) - and gastric - tube reconstruction in Abdominal Surgery Department II at National K Hospital from 10/2017 to 7/2020. Descriptive study, patients were observed during hospitalization. Results: Mean age 56,8 ± 6,77 (min 35 - max 72), lymph node metastasis was 17,8%, T1 was 35,6%, T2 was 48,9% and T3 was 15,5%, squamous cell carcinoma accounted for 97,7%. Mean operative time was 226 ± 6 minutes, mean hospital stay was 15,2 ± 4,6 days, anastomosis leakage accounted for 6,1%, anastomosis stenosis was 15,3%, vocal cord palsy was 4,6% and pneumonia happened in 13,8%. Conclusions: Esophagectomy is a major surgery procedure that could be perform by thoraco-laparoscopy with good result.

The Complications between Different Routes of Reconstruction after Esophagectomy

Background The main purpose of this study was to compare the postoperative complications caused by surgical reconstruction via either retrosternal (RS) or prevertebral (PV) routes in thoracoscopic and laparoscopic esophagectomy patients. Materials and Methods We retrospectively screened the perioperative data in total 59 patients who underwent minimally invasive esophagectomy in time period from January 2016 to January 2018. All the patients were subgrouped into two cohorts according to the surgical routes being taken: the RS route group (28 patients) and the PV route group (31 patients). The perioperative data including operation and hospitalization time and surgical complications were comparatively analyzed. Results The surgical procedure in all patients was successful and no case of death occurred during perioperative stage in both groups. Notably, patients in the RS group had significantly lower propensity of pneumonia than patients in the PV group (p < 0.05). However, comparative analysis revealed almost an identical time for both operative process and postoperative hospitalization. And there was no statistical significance in the rate of anastomotic leakage and stricture as well as other complications (p > 0.05). Conclusion RS and PV paths are both safe and effective routes that yielded similar postoperative complications. Reconstruction after thoracoscopic and laparoscopic esophagectomy via the RS route had lower propensity of pneumonia than PV route.