Comparative Study On Therapeutic Effect Of Thoracoscopic-laparoscopic Esophagectomy And Traditional Open Esophagectomy

Objective:Thoracoscopic-laparoscopic esophagectomy is the development direction of minimally invasive surgery at present. The study compared the thoracoscopic-laparoscopic esophagectomy with traditional open esophagectomy to discuss the therapeutic effect of thoracoscopic-laparoscopic esophagectomy and traditional open esophagectomy for carcinoma, then studied the recent clinical effect as well as safety and feasibility of thoracoscopic-laparoscopic esophagectomy.Methods: One hundred and seventy-eight patients who underwent esophagectomy for cancer were selected and analyzed in thoracic surgery of a hospital from February 2012 to February 2015. Eighty were treated by thoracoscopic-laparoscopic esophagectomy(endoscope group for short);ninety-eight were treated by traditional open esophagectomy(open group for short) at the same period. The two group were compared by retrospectrve study. There were fifty-one males and twenty-nine females in endoscope group, mean being 59.4. One patients with upper thirs esophageal cancer.sixty-six with middle third lesion and 14 with lower thid lesion. There were sixty-five males and hirty-three females in open group, with a mean sge of60.7. Cancer was located at middle third if the esophagus in seventy-nine patients, at lower thid of the esophagus in nineteen. The therapeutic effect of thoracoscopic-laparoscopic esophagectomy and traditional open esophagectomy for carcinoma were discussed by comparing the time of operatin, number of lymph node resected, amount of intraoperative bleeding,postoperative chest tube time,postoperative volume of drainage,postoperative pathological stage, postoperative length of hospital stay and postoperative monitoring time between the two group.Then study the safety, feasibility,redical and recent clinical effect of thoracoscopic-laparoscopic esophagectomy furtherly. The data was analyzed with SPSS13.0. Quantitative data,corresponding to normal distribution expressed with c±s and compared with T test. Quantitative data corresponding against normal distribution expressed with M. Qualitative data was compared with chi-square test. The difference was statistical significance if P < 0.05.Results1The comparative data includedsexAlcohol history, tobacco history, tumor location and preoperative complications of patients. The results showed that the differences between the two groups has no statistical significance(P>0.05).2The comparison of postoperative esophageal carcinoma TNM stagingThe postoperative TNM stage of endoscope group as followed: 35 patients were at stage I, including 11 patients at stage IA and 24 patients at stage IB; 29 patients were at stage II, including 14 patients at stage IIA and 15 patients at stage IIB; 16 patients were at stage III, including 16 patients at stage IIIA. The postoperative TNM stage of open group as followed: 39 patients were at stage I, including 17 cases at stage IA and 22 cases at stage IB; 34 patients were at stage II, including 19 cases at stage IIA and15 cases at stage IIB; 25 patients were at stage III, including 25 cases at stage IIIA. The results of the comparsion groups of postoperative esophageal carcinoma TNM stages showed that there was no statistically significant difference between the two groups(P>0.05), and thus the postoperative treatment effect of the two groups was comparable.3There were significant differencesIn the operation time, amount of intraoperative bleeding, drainage volum at first day, hospitalization time and chest thainagee time between the two groups(P<0.05). There were no significant diferneces in postoperative monitoring time and postoperative hospital stay between the two groups.4There were no significant diffenrces in the resected number of lymph node of paraesophagus,Paratrachea, carina and lower pulmonary vein side, bosom and abdomen between the two groups,(P > 0.05).5The comparsion of postoperative complications:In the endoscope group, 3 cases had anastomotic fistula(8.6%), 2 cases had anastomotic stricture(5.7%), 1 case had recurrent laryngeal nerve injury(2.9%), 2 cases had delayed gastric emptying(5.7%), 2 cases had arrhythmia(5.7%), 3 cases had pulmonary infection(8.6%), 2 cases had atelectasis(5.7%), 1 cases had pneumothorax(2.9%). In open group, 1 case had anastomotic fistula(2.4%), 3 cases hadanastomotic stricture(7.1%), 1 case had recurrent laryngeal nerve injury(2.4%), 2 cases had delayed gastric emptying(4.8%), 3 cases hadarrhythmia(7.1%), 1 case had heart failure(2.4%),5 cases had delayed gastric emptying(11.9%), 3 cases had atelectasis(7.1%), 2cases had pneumothorax(4.8%). The postoperative complications of the two group had no statistical significance(P>0.05).6Two groups after esophagectomyFollowed up for 2 to 45 months. Average follow-up time was(19.5±11.5)months. The Median follow-up time was 19 months. The follow-up cases were 75. Average follow-up time was(20.6±11.3) months.The Median follow-up time was 19 months.There had no recurrence or metastasis. The follow-up cases were 92. Average follow-up time was(19.2±11.7) months. The Median follow-up time was 19 months.There had no recurrence or metastasis. The number of follow-up patient, the follow-up time,recurrence and metastasis of the two group had no statistically significant difference(P > 0.05).Conclusion:1 Thoracoscopic-laparoscopic esophagectomy had the same therapeutic effect as open esophagectomy, both could reach radical treatment of esophageal carcinoma. It had good early good results. Thoracoscopic-laparoscopic esophagectomy was safe and feasible, conforming to the principle of a radical cure effect of surgical oncology.2 Thoracoscopic-laparoscopic esophagectomy had many advantages suchas small incision, less intraoperative blood bleeding, thorough lymph node cleaning, high operation safety, light pain, less postoperative complications.