Complete Video-assisted Thoracic Surgery Is More Favorable Than Thoractomy For Radical Operation On Stage â… ,â…¡esophageal Carcinoma

Objective To compare the results and safety between video-assisted thoracic surgery(VATS)radical operation and conventional thoractomy in patients with stageⅠ,Ⅱesophageal carcinoma. Methods From September 2007 to March 2010,video-assisted thoracoscopic esophagectomy was performed in 36 patients. There were 22 men , 14 women. Median age was 60.5 years ( range ,38 - 78) . Under thoracoscopy via thoracic and cervical incisions, the esophagus and tumor were disconnected and the intrathoracic lymph nodes were cleared through the right thorax. Then a median incision was made at the epigastrium. Through the incision the stomach was disconnected and intraabdominal lymph nodes were removed. Afterwards, esophagectomy and gastroesophagostomy were performed by way of the cervical incision. Retrospectively reviewed 72 patients with stageⅠ,Ⅱesophageal carcinoma underwent either VATS radical operation (VATS group,n=36) or standard radical operation via thoractomy (open group,n=36) . Patients's operative characteristics and postoperative courses were comparable between two groups. Results The results were satisfactory and no operative mortality , anastomotic leak 2 case , chylothorax 2 case . The operative time was (110.56±36.41)min in the VATS group and (133.33±22.55)min in the open group(P<0.05);The number of mediastinal lymphonode resection was (11.47±5.91) and (16.19±8.54)(P<0.05);The time of postoperative chest tube was(6.53±1.87)d and(9.89±2.61)d(P<0.001);The postoperative pain(VAS) was (3.36±0.96) and(6.81±1.72)(P<0.001);The postoperative locomotor activity of right upper extremity was(5.08±1.27)cm and (16.00±3.62)cm(P<0.001). Conclusion Compare with thoractomy,VATS thoracic surgery for patients with stageⅠ,Ⅱesophageal carcinoma appears to be as effective but less morbid . Video-assisted thoracoscopic esophagectomy is technically feasible and safe. It has the potential to replace open esophagectomy in selected patients. However, the VATS can not fill the place of thoracotomy for its limitedness. Regular thoracotomy is preferable in cases of high risks or with larger tumor. Thoracoscope has its indications in treatment of the esophageus carcinoma. Strict requirement of the doctors thoracoscope skill must be performed. Dispute was exist in the use of thoracoscope. Total negation or blind application would holdback the development of thoracoscope surgery .