title: Gastric tube reconstruction by laparoscopy-assisted surgery attenuates postoperative systemic inflammatory response after esophagectomy for esophageal cancer.
abstract: BACKGROUND
  Conventional open procedures have been supplanted in part by less invasive approaches, such as laparoscopic surgery developed for treating gastrointestinal malignancies. However, it is unclear whether laparoscopy-assisted gastric tube reconstruction (LAGT) can attenuate the postoperative systemic inflammatory response after esophagectomy for esophageal cancer.
  
  
  METHODS
  We investigated the postoperative clinical course of the systemic inflammatory response syndrome (SIRS) in patients who underwent an esophagectomy for esophageal cancer by LAGT (LAGT group) and gastric tube reconstruction by conventional open surgery (Open group).
  
  
  RESULTS
  Compared with the Open group, the LAGT group had a significantly shorter operative time (539.6 min vs. 639.8 min), shorter duration of postoperative mechanical ventilation (1.1 days vs. 2.8 days), and shorter length of stay in the intensive care unit (2.1 days vs. 4.4 days). The LAGT group also had a significantly shorter SIRS duration (1.4 days vs. 2.7 days), a significantly lower incidence of SIRS, and a smaller number of positive SIRS criteria. Throughout the investigation period, the postoperative white blood cell count was lower in the LAGT group than in the Open group. Additionally, in the LAGT group, the heart rate was lower on each postoperative day (POD), and the respiratory rate was significantly lower on postoperative days (PODs) 1 and 4. There was no difference in postoperative oxygenation, morbidity, and mortality between the groups. The C-reactive protein level on PODs 3 and 4 was significantly lower in the LAGT group than in the Open group.
  
  
  CONCLUSIONS
  Laparoscopy-assisted gastric tube reconstruction significantly attenuates postoperative SIRS, and it is therefore a potentially less invasive surgical procedure.
authors: Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan. tsujihi@ndmc.ac.jp
authors: Hironori
authors: H
authors: Tsujimoto
authors: Satoshi
authors: S
authors: Ono
authors: Hidekazu
authors: H
authors: Sugasawa
authors: Takashi
authors: T
authors: Ichikura
authors: Junji
authors: J
authors: Yamamoto
authors: Kazuo
authors: K
authors: Hase
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D013270:Stomach / Q000601:surgery*; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000517:prevention & control*