title: Comparison of thoracolaparoscopic esophagectomy with cervical anastomosis with McKeown esophagectomy for middle esophageal cancer.
abstract: BACKGROUND
  In China, the middle esophageal squamous cell cancer is the most common tumor type, and Mckeown esophagectomy (ME) is preferably adopted by thoracic surgeon. But, the surgical trauma of ME is great. Thoracolaparoscopic esophagectomy (TE) was developed to decrease the operative stress; however, the safety and efficacy were not defined. In this study, clinical outcomes were compared between patients who received ME and TE.
  
  
  METHODS
  The data of 113 patients who suffered from middle-thoracic esophageal cancer during the same period were collected. Sixty-two patients received ME (ME group), and 51 patients received TE (TE group). Patients' demographics and short-term clinicopathologic outcomes were comparable between the two groups. Survival rate was estimated using the Kaplan-Meier method, and comparisons between groups were performed with log-rank test.
  
  
  RESULTS
  Patients in TE group had lower body mass index (BMI). Preoperative tumor stage in TE group was much earlier. Both overall and thoracic operation time were longer in TE group. The blood loss during operation and postoperative day (POD) 1 was less in TE group, which contributed to the less blood transfusion. In TE group, postoperative incidence of pulmonary complications and atrial fibrillation (p = 0.035 and p = 0.033) was lower; the inflammatory response and incision pain were significantly alleviated; the ICU and in-hospital stay was shorter as well because of less surgical trauma. No statistically significant difference was found between two groups in terms of overall survival or disease-free survival.
  
  
  CONCLUSIONS
  The efficacy and safety of TE were supported by the selected patients in this cohort study. Although it is lack of randomness in this research, some advantages of TE were gratifying such as lower postoperative complications and similar survival with ME. A multicenter prospective randomized study is now required.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Nantong First People's Hospital, the Second Affiliated Hospital of Nantong University, No.6 North Hai'er Xiang Road, Nantong, 226001, People's Republic of China. hht1979@126.com.
authors.forename: Hai-Tao
authors.initials: HT
authors.lastname: Huang
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Nantong First People's Hospital, the Second Affiliated Hospital of Nantong University, No.6 North Hai'er Xiang Road, Nantong, 226001, People's Republic of China. wangfnt@126.com.
authors.forename: Fei
authors.initials: F
authors.lastname: Wang
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Nantong First People's Hospital, the Second Affiliated Hospital of Nantong University, No.6 North Hai'er Xiang Road, Nantong, 226001, People's Republic of China. shenlntyy@126.com.
authors.forename: Liang
authors.initials: L
authors.lastname: Shen
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Nantong First People's Hospital, the Second Affiliated Hospital of Nantong University, No.6 North Hai'er Xiang Road, Nantong, 226001, People's Republic of China. xiachunqiunt@126.com.
authors.forename: Chun-Qiu
authors.initials: CQ
authors.lastname: Xia
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Nantong First People's Hospital, the Second Affiliated Hospital of Nantong University, No.6 North Hai'er Xiang Road, Nantong, 226001, People's Republic of China. luchenxint@126.com.
authors.forename: Chen-Xi
authors.initials: CX
authors.lastname: Lu
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Nantong First People's Hospital, the Second Affiliated Hospital of Nantong University, No.6 North Hai'er Xiang Road, Nantong, 226001, People's Republic of China. zhongcjnt@126.com.
authors.forename: Chong-Jun
authors.initials: CJ
authors.lastname: Zhong
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002681:China; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015996:Survival Rate; D013906:Thoracoscopy; D016896:Treatment Outcome