title: [Thoracoscopic and laparoscopic esophagectomy in the treatment of esophageal carcinoma: clinical analysis of 350 cases].
abstract: OBJECTIVE
  To investigate the clinical efficacy and learning curve of thoracoscopic and laparoscopic esophagectomy(TLE) in the treatment of esophageal carcinoma.
  
  
  METHODS
  Clinical data of 350 consecutive patients with esophageal carcinoma undergoing TLE in the West China Hospital between February 2008 and October 2013 were retrospectively analyzed. Patients in the early stage(n=150) were chronologically and evenly divided into three groups, and perioperative outcomes were compared between the three groups in order to evaluate the learning curve.
  
  
  RESULTS
  There were no intraoperative deaths. Intraoperative complications occurred in 29(8.3%) patients. Thirteen(3.7%) cases were converted to open operation including 9 thoracotomy and 4 laparotomy. The mean operative time was 332.5(range 230-780) min and the mean blood loss was 160.8(range 15-4000) ml. The tumor free resection margins (R0) were completely in 333(95.1%) cases. The mean lymph nodes harvested was 21.6(range 6-42). The average length of postoperative hospital stay was 11.6(range 7-93) d. Postoperative complications occurred in 75(21.4%) patients, and 3(0.8%) patients died within 30 days after surgery. Compared with TLE 1 group, TLE 2 group presented shorter operative time, less blood loss, shorter postoperative hospital stay, lower postoperative complication rate, and more lymph nodes harvested(all P<0.05). Only blood loss was less in TLE 3 group as compared to TLE 2 group, and other perioperative results were found to be of no statistical differences between the two groups. There was no significant difference in 30-day mortality between the three groups.
  
  
  CONCLUSIONS
  TLE is a technically feasible and safe procedure and provides comparable oncological outcomes with open esophagectomy, thus suggesting that TLE is an alternative approach in the treatment of esophageal carcinoma. A plateau of TLE skill can be reached after 50 surgical procedures.
authors: Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China. hxwangyun@foxmail.com.
authors: Zhenming
authors: Z
authors: Zhang
authors: Yu
authors: Y
authors: Song
authors: Yongshan
authors: Y
authors: Gao
authors: Yun
authors: Y
authors: Wang
mesh_terms: D002681:China; D004938:Esophageal Neoplasms; D016629:Esophagectomy; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008197:Lymph Node Excision; D008198:Lymph Nodes; D061646:Operative Time; D011183:Postoperative Complications; D012189:Retrospective Studies