Soji Ozawa, MD, PhD, Junya Oguma, MD, PhD, Akihito Kazuno, MD, Miho Nitta, MD, Yamato Ninomiya, MD, Kentarou Yatabe, MD. Department of Gastroenterological Surgery, Tokai University School of Medicine, Kanagawa, Japan
INTRODUCTION: The purpose of this study was to clarify the long-term and short-term outcomes of 330 consecutive patients who underwent thoracoscopic esophagectomy in the prone position using a preceding anterior approach for the resection of esophageal cancer at a single institution. This method was established to make an esophagectomy easier to perform and to achieve better outcomes in terms of safety and curativity.
METHODS AND PROCEDURES: We retrospectively reviewed a database of 673 patients with thoracic esophageal cancer who had undergone a thoracoscopic esophagectomy (TE, 330 patients) or an esophagectomy through thoracotomy (OE, 343 patients) between January 2003 and August 2017. To compare the long-term outcomes of TE and OE, we used a propensity score matching analysis and a Kaplan-Meier survival analysis. To analyze the short-term outcomes of TE, patients were chronologically divided into three groups: a first period group (110 patients), a second period group (110 patients), and a third period group (110 patients). As for thoracoscopic procedure, the esophagus was mobilized from the anterior structure during the first step and from the posterior structure during the second step. The lymph nodes around the esophagus were also dissected anteriorly and posteriorly. The intraoperative factors, the number of dissected lymph nodes, and the incidence of adverse events were compared among the three period groups using a one-way ANOVA or chi-square test.
RESULTS: One hundred and twenty-three patients from each group, for a total of 246 patients, were completely selected and paired. The 5-year survival of the TE patients (67.0%) was not different from that of the OE patients (58.1%) (P = 0.296). The thoracoscopic times were 227 min, 242 min, and 217 min (P < 0.05), and the blood losses during the thoracoscopic procedure were 36.2 mL, 44.8 mL, and 19.5 mL (P < 0.05), respectively, according to the period groups (110 patients each). The mean numbers of harvested lymph nodes in the mediastinum were 22.0, 25.1, and 28.5 (P < 0.05). The rates of recurrent laryngeal nerve palsy were 23.6%, 32.7%, and 6.4% (P < 0.001).
CONCLUSIONS: The long-term outcome of TE patients might not differ from that of OE patients. As for the short-term outcomes, intraoperative factors, quality of lymph node dissection, and reduction of adverse events were best in the third period group. After accumulating more than 220 operations, our method of TE can be regarded as a safe and effective procedure for esophageal cancer surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86471
Program Number: P463
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster