title: Pharyngolaryngoesophagectomy using the thoracoscopic approach.
abstract: BACKGROUND
  Thoracoscopic mobilization of the esophagus for pharyngolaryngoesophagectomy allows dissection under direct vision, and therefore it potentially results in fewer complications than conventional transhiatal mobilization. In this article we report our experience with this approach. It was also hypothesized that a learning curve existed and that results have improved over time.
  
  
  METHODS
  From July 1994 until January 2004, 57 patients underwent pharyngolaryngoesophagectomy in our institution. Intraoperative events and postoperative outcome were prospectively documented, and long-term follow-up data were also studied. Results were compared between the first 30 patients and the last 27 patients.
  
  
  RESULTS
  There were no significant differences between the two groups with respect to the various clinicopathological characteristics. There was no difference in the median thoracoscopic time between the first 30 and last 27 patients at 90 and 75 min, respectively, p = 0.18. For the complete procedure there was significantly less blood loss in the later group; median (range) blood loss 700 (164-3000) ml versus 400 (100-1200) ml, p = 0.002. Overall pulmonary complications occurred in 12 patients (40%) in the first group versus 13 (48%) in the second group, p = 0.6. The incidence of atrial arrhythmia was also similar, affecting 6 (20%) patients and 3 (11%), respectively, p = 0.47. Hospital mortality rates were 13.3% and 7.4%, p = 0.67. Two-year survival rates were no different (46% versus 45% p = 0.85).
  
  
  CONCLUSIONS
  Although, subjectively, operating skills have improved over time, better results in the second half of this series could not be demonstrated clearly, likely because the operating surgeons had prior extensive experience in esophageal and thoracoscopic procedures.
authors.affiliation: Division of Esophageal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
authors.forename: H A
authors.initials: HA
authors.lastname: Cense
authors.forename: S
authors.initials: S
authors.lastname: Law
authors.forename: W
authors.initials: W
authors.lastname: Wei
authors.forename: L-K
authors.initials: LK
authors.lastname: Lam
authors.forename: W-M
authors.initials: WM
authors.lastname: Ng
authors.forename: K-H
authors.initials: KH
authors.lastname: Wong
authors.forename: K-F
authors.initials: KF
authors.lastname: Kwok
authors.forename: J
authors.initials: J
authors.lastname: Wong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D010039:Otorhinolaryngologic Neoplasms / Q000601:surgery; D010611:Pharyngectomy; D011446:Prospective Studies; D013906:Thoracoscopy / Q000706:statistics & numerical data*; D013964:Thyroid Neoplasms / Q000601:surgery