title: Video-assisted thoracoscopic surgery for esophageal cancer attenuates postoperative systemic responses and pulmonary complications.
abstract: BACKGROUND
  Less invasive operations such as laparoscopic surgery have been developed for treating gastrointestinal malignancies. However, the advantages of video-assisted thoracoscopic surgery for esophageal cancer (VATS-e) with regard to postoperative morbidity and mortality remains controversial.
  
  
  METHODS
  We investigated the postoperative clinical course of patients who underwent esophagectomy for esophageal cancer in terms of systemic inflammatory response syndrome (SIRS) induced by VATS-e (VATS-e group) or conventional open surgery (OS group) combined with laparoscopic gastric tube reconstruction.
  
  
  RESULTS
  Compared with the OS group (n = 27), the VATS-e group (n = 22) had a greater thoracic operation time (VATS-e versus OS, 181 ± 56 vs 143 ± 45 minutes, respectively), and lesser duration of stay in the intensive care unit (17 ± 2 vs 32 ± 21 hours, respectively). The VATS-e group also had a lesser SIRS duration (1.5 vs 4.3 days), a lesser incidence of SIRS, a lesser number of positive SIRS criteria, and lesser serum interleukin-6 levels immediately after operation and on postoperative day (POD) 1. The heart rate in the VATS-e group was less than that in the OS group on POD 3. The respiratory rate in the VATS-e group was significantly less than that in the OS group on PODs 3, 5, and 7. Although no difference was observed in the frequencies of postoperative complications between the 2 groups, the VATS-e group had less postoperative pneumonia.
  
  
  CONCLUSIONS
  VATS-e attenuates postoperative SIRS, and is therefore a potentially less invasive operative procedure.
authors.affiliation: Department of Surgery, National Defense Medical College, Tokorozawa, Japan. tsujihi@ndmc.ac.jp
authors.forename: Hironori
authors.initials: H
authors.lastname: Tsujimoto
authors.forename: Risa
authors.initials: R
authors.lastname: Takahata
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Nomura
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Yaguchi
authors.forename: Isao
authors.initials: I
authors.lastname: Kumano
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Matsumoto
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Yoshida
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Shuichi
authors.initials: S
authors.lastname: Hiraki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ono
authors.forename: Junji
authors.initials: J
authors.lastname: Yamamoto
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hase
mesh_terms: D000368:Aged; D016207:Cytokines / Q000097:blood; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome
chemical_list: D016207:Cytokines