Clinical application and observation of single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal squamous cell carcinoma

• Published in: Journal of cardiothoracic surgery Vol. 15; no. 1; pp. 1 - 125
• Main Authors: Yin, Qifan, Liu, Huining, Song, Yongbin, Zhou, Shaohui, Yang, Guang, Wang, Wenhao, Qie, Peng, Xun, Xuejiao, Liu, Lijun
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 05-06-2020; BioMed Central; BMC
• Subjects: Abdomen; Blood; Cancer; Cancer research; Cardiovascular disease; Comorbidity; Complications; Conversion; Cough; Dissection; Drinking water; Esophageal cancer; Esophageal carcinoma; Esophagus; Feasibility studies; Gastrointestinal surgery; Inflatable mediastinoscopy and laparoscopy; Laparoscopy; Lymph nodes; Lymphatic system; Mediastinoscopy; Medical prognosis; Mortality; Neck; Nodes; Non-transthoracic esophagectomy; Ostomy; Patients; Peritoneum; Pleural effusion; Risk analysis; Risk factors; Safety; Squamous cell carcinoma; Stomach; Stricture; Surgery; Surgical drains; Wound drainage
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-020-01168-1

Background Transthoracic esophagectomy is a crucial independent risk factor for the incidence of postoperative cardiopulmonary complications in elderly or comorbid patients. To reduce postoperative cardiopulmonary complications and promote postoperative recovery. We made an attempt to adopt the single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal cancer to observe the clinical application and effect. Method Data of patients with esophageal carcinoma were collected in the Hebei General Hospital from May 2018 to November 2019. The operation time, surgical blood loss, the number of dissected lymph nodes, duration of drainage tube, duration of time on the ventilator, the length of stay in ICU, postoperative complications, the length of postoperative hospital stay were collected to assess the safety and feasibility of the single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal cancer. Results A total of 22 patients with esophageal cancer were analyzed in our research. There were no cases of conversion to thoracotomyãperioperative death or postoperative cardiopulmonary complications. The average operation time of all enrolled patients was 4.26 [+ or -] 0.52 hãThe surgical blood loss was 142 [+ or -] 36.50 mlãThe amount of dissected lymph nodes were 21.6 [+ or -] 4.2ãThe duration of drainage tube was 5.8 [+ or -] 2.5 daysãThe duration of time on the ventilator was 6.5 [+ or -] 3.4 hãThe length of stay in ICU was 1.2 [+ or -] 0.4 daysãThe postoperative hospital stay was 12.6 [+ or -] 2.5 days. Among all the enrolled patients, one patient (4.5%) developed anastomotic fistula on the third day after surgery. Anastomotic stricture was found in 5 patients (22.7%). Pleural effusion was found in 4 cases (18.2%). Recurrent laryngeal nerve injury caused hoarseness or cough after drinking water in 3 cases (13.6%).There was one patient (4.5%) of conversion to laparotomy as the patient had serious peritoneal adhesion. All of the patients were discharged successfully. Conclusion:Our results showed that this surgery of single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal squamous cell carcinoma is safe and feasible. The feasibility and safety could be further and better investigated with a RCT to achieve more conclusive results. Keywords: Esophageal cancer, Non-transthoracic esophagectomy, Inflatable mediastinoscopy and laparoscopy