Two-ropes Method For Dissecting Esophagus In McKeown MIE

Objective: Minimally invasive Mc Keown esophagectomy(Mc Keown MIE)is the main method for surgical treatment of esophageal cancer in many hospitals in China.However,there are few studies on how to improve the method in freeing esophagus and dissecting lymph nodes under thoracoscopy.In this regard,we introduce a simple and feasible method named two-ropes method,which is improved on the basis of esophageal suspension method.To explore the feasibility of this method in the dissociation of thoracic esophagus and the dissection of thoracic lymph nodes,and to explore the safety of two-ropes method in patients with postoperative complications,surgical trauma and oncology indicators.Methods: Retrospective analysis was performed on 112 patients who underwent Mc Keown MIE in our center from January 2019 to September 2021.According to whether two-ropes method were used to suspend the esophagus to expand the surgical field and clean the lymph nodes,the patients were divided into two groups: group A(Two-ropes group,45 cases)and group B(Regular group,67 cases).Age,gender,BMI,comorbidities,tumor location and TNM stage were used as covariates,and create a propensity score matching pair with the 1:1nearest neighbor matching method.The caliper was set to 0.05.After propensity score matching,the total operation time,thoracic operation time,number of thoracic lymph node dissection,the size of abdominal median incision and postoperative complications were compared between the two groups.Results: We successfully matched 41 pairs of patients.The total operation time(237.66 ± 30.34 min vs.270.68 ± 43.10 min;P< 0.01),thoracic operation time(70.93 ± 8.88 min vs.87.98 ± 14.28 min;P <0.01),the time required to remove the free-stomach and free-esophagus through the abdominal median incision(15.24 ± 3.81 s vs.166.1 ± 28.19s;P < 0.01);the size of abdominal median incision(4.01 ± 0.54 cm vs.6.26 ± 1.09 cm;P < 0.01)in group A were significantly smaller than those in group B.There was no significant difference in the number of thoracic lymph node dissection between the two groups(P > 0.05).There was no significant difference in postoperative complications such as pulmonary infection,anastomotic leakage,recurrent laryngeal nerve injury and chylothorax between the two groups(P > 0.05).Conclusion: In Mc Keown MIE,compared with regular method,the two-ropes method requires less operation time and the number of lymph node dissection can be kept consistent.It is more convenient to drag the stomach and esophagus out of the abdominal cavity and leave a smaller surgical incision in the abdomen.The esophageal dissociation method is safe and feasible.