Video-assisted thoracoscopic esophagectomy and radical lymph node dissection for esophageal cancer. A series of 75 cases.
BACKGROUND
The efficacy of thoracoscopic radical esophagectomy for cancer has yet to be established, mainly because previous reports have not included a sufficient number of cases.


METHODS
Seventy-five treatment-naive patients with esophageal cancer without contiguous spread underwent esophageal mobilization and extensive mediastinal lymphadenectomy through a 5-cm mini-thoracotomy and four trocar ports.


RESULTS
Video-assisted thoracoscopic surgery was performed without major intraoperative complications or emergency conversion to open surgery. We retrieved 34.1+/-13.0 mediastinal nodes, including 11.5+/-3.8 tracheobronchial nodes and 6.2+/-3.0 recurrent laryngeal nodes. Mean time of operation and blood loss were less in the last 39 patients than the first 36 (186.7+/-25.3 min and 165.4+/-101.8 g vs 270. 2+/-96.0 min and 421.5+/-31.2 g, respectively: p <0.0001 and p <0.001). Pulmonary morbidity was 5% in the later 39 patients. Survival was 90%, 80%, and 57% at 1, 2, and 5 years after surgery.


CONCLUSIONS
Thoracoscopic radical esophagectomy has less morbidity and comparable survival to conventional surgery, after a moderate amount of experience. Mini-thoracotomy is essential to perform the procedure safely and effectively.
Osugi
H
H
Department of Gastroenterological Surgery, Osaka City University Medical School. m9940141@msic.med.osaka-cu.ac.jp
Takemura
M
M
Higashino
M
M
Takada
N
N
Lee
S
S
Ueno
M
M
Tanaka
Y
Y
Fukuhara
K
K
Hashimoto
Y
Y
Fujiwara
Y
Y
Kinoshita
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007830:Larynx / Q000601:surgery; D008171:Lung Diseases / Q000453:epidemiology; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008482:Mediastinum / Q000601:surgery; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013997:Time Factors