Thoracoscopic And Laparoscopic 2-fieles Lymphadenectomy For The Treatment Of Esophageal Carinoma

ObjectiveTo explore the feasibility and safety of thoracoscopic and laparoscopic 2-fields lymphadenectomy for the treatment of esophageal carcinoma.MethodsThoracoscopic and laparoscopic 2-field lymphadenectomy was attempted in 86 patients with esophageal carcinoma between November 2009 and December 2010. Being placed at a left lateral decubitus position,the patients received right thoracoscopic mobilization of the intrathoracic esophagus as well as systemic lymph node dissection;then with lithotomy position,laparoscopic mobilization of the stomach and lymph node dissection were carried out.To analysis the number of each site of thoracic and celiac field lymph nodes as well as major postoperative complications.ResultsTotally 2106 lymph nods were removed (25.1per patient in average).The thoracic field lymph nodes were 14.4 per case. Celiac field lymph nodes were 9.9 per case.Of the resected lymph nodes, paraesophageal lymph nodes were 5.2 per case,subcarinal lymph nodes were 3.9 per case, the right and left side of recurrent laryngeal nerve lymph nodes were 2.6 and 1.8 per case respectively, cardiac lymph nodes were 4.5 per case,and para left gastric arterial lymph nodes were 1.9 per case. Two of the patients was converted to open thoracic operation. The total mean operation time was 350.5±63.3 mins,the operation time for laparoscopy was 135.2±42.7 mins,and for thoracoscopy was 157.7±36.0 mins.No massive hemorrhage occurred during the operation,the total blood loss was 173.5±94.5ml. During the hospitalization,no patient died;postoperative complications included pulmonary infection (4 cases), arrhythmia (7 cases) ,cervical anastomotic leak( 11 cases), chylothorax (3 cases), hoarseness(8 cases) and delayed gastric emptying(9 cases).ConclusionThoracoscopic and laparoscopic 2-fields lymphadenectomy is feasible and safe for the treatment of esophageal carcinoma.