Elsevier

International Journal of Surgery

Volume 48, December 2017, Pages 105-109
International Journal of Surgery

Original Research
Is thoracoscopic-laparoscopic esophagectomy a better alternative to thoracoscopic esophagectomy?

https://doi.org/10.1016/j.ijsu.2017.10.036Get rights and content
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Highlights

  • TLE is a safe and effective alternative to TE.

  • Compared with TE, TLE can provide more short-term benefits to patients with esophageal cancer.

  • TLE did not decrease postoperative complications when compared with TE.

Abstract

Background

Minimally invasive esophagectomy (MIE) is gaining rapid popularity as an alternative to conventional open esophagectomy. However, whether incorporating laparoscopy into MIE can further help the patients with esophageal cancer has rarely been studied. The aim of this study was to evaluate the short-term clinical efficacy of thoracoscopic-laparoscopic esophagectomy (TLE) compared with thoracoscopic esophagectomy (TE) in treating esophageal cancer.

Methods

From September 2014 to December 2016, a total of 131 patients with esophageal cancer who had consecutively undergone MIE were included in the analysis; of them, TLE was performed in 71 patients and TE in 60 patients. Characteristics and perioperative outcomes of all patients were collected and compared to determine differences between the 2 groups.

Results

Operation time (p = 0.172), chest drainage volume (p = 0.656), and pathologic staging (p = 0.671) were similar in the 2 groups. Compared with the TE approach, the TLE approach was associated with less blood loss during the operation (median, 100 vs 150 ml, p < 0.001), shorter chest drainage time (median, 2 vs 3 days, p < 0.001), a larger number of harvested lymph nodes (median, 24 vs 20, p < 0.001), and shorter postoperative hospital stay (median, 10 vs 11 days, p = 0.008). There was no significant difference between groups with regard to the major (grade ≥ III) and minor (grade < III) complications.

Conclusions

TLE is a safe and effective alternative to TE. Patients undergoing TLE may benefit from less blood loss, a larger number of harvested lymph nodes and faster postoperative recovery. Additional randomized controlled trial with longer follow-up is needed.

Keywords

Esophagectomy
Thoracoscopy
Laparoscopy
Esophageal cancer

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