title: Mediastinoscopy-assisted oesophagectomy in T1 oesophageal cancer patients with serious comorbidities: a 5-year long-term follow-up.
abstract: OBJECTIVE
  Transthoracic oesophagectomy is associated with high morbidity and mortality. Some oesophageal cancer (OC) patients with serious comorbidities cannot tolerate transthoracic oesophagectomy. Therefore, we have adopted a minimally invasive approach to oesophagectomy for such patients.
  
  
  METHODS
  Eighty-five OC patients, who could not tolerate transthoracic oesophagectomy, received mediastinoscopy-assisted oesophagectomy (MAO) from January 2007 to January 2010 in our hospital. Seventy patients were confirmed to be in T1 stage by postoperative pathological diagnosis, and their complications and outcomes were retrospectively analysed in this study. The impact of invasion depth, tumour length and lymph node metastases on the 5-year survival rate of these patients was also analysed.
  
  
  RESULTS
  The operation time was 150.0 ± 15.0 min, and the perioperative bleeding volume was 202.0 ± 12.8 ml. Some patients had anastomotic leakage (5 cases), pneumonia (4 cases) and chylothorax (1 case). No patient died during hospitalization. The median postoperative hospital stay was 10 (7-22) days. The number of lymph nodes resected was 13.8 ± 4.4. The overall 5-year survival rate was 71%. Kaplan-Meier estimates revealed that tumour length (<2 vs ≥ 2 cm), lymph node metastasis (N0 vs N1) and depth of invasion (T1a vs T1b) could influence the 5-year survival rate (P <0.05). Multivariate analysis by Cox regression showed that lymph node metastasis and tumour length were independent prognostic factors for the 5-year survival rate (P <0.05).
  
  
  CONCLUSIONS
  MAO could be performed for T1 OC patients with serious comorbidities who cannot tolerate transthoracic oesophagectomy. Lymph node metastasis and tumour length were independent prognostic factors for these patients.
authors.affiliation: Department of Cardiothoracic Surgery, The First People's Hospital of Changzhou, the Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Cardiothoracic Surgery, The First People's Hospital of Changzhou, the Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China.
authors.forename: Nan-Qing
authors.initials: NQ
authors.lastname: Jiang
authors.affiliation: Department of Cardiothoracic Surgery, The First People's Hospital of Changzhou, the Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Jiang
authors.affiliation: Department of Cardiothoracic Surgery, The First People's Hospital of Changzhou, the Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China.
authors.forename: Zhong-Lin
authors.initials: ZL
authors.lastname: Wang
authors.affiliation: Department of Cardiothoracic Surgery, The First People's Hospital of Changzhou, the Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China dr_zhangxiaoying@126.com.
authors.forename: Xiao-Ying
authors.initials: XY
authors.lastname: Zhang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D015897:Comorbidity; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008207:Lymphatic Metastasis; D008297:Male; D008481:Mediastinoscopy / Q000009:adverse effects / Q000401:mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Comorbidities; Mediastinoscopy-assisted oesophagectomy; Oesophageal cancer; Outcomes