A Comparision Of Clinical Outcomes Between Thoracolaparoscopy Ivor-Lewis Esophagectomy Approach And Open Ivor-Lewis Approach For Middle And Lower Thoracic Esophageal Cancer

Objectives: To investigate the safety,feasibility and short-term efficacy of Minimally Invasive Ivor-Lewis Esophagectomy(MIILE approach)in the treatment of middle and lower thoracic esophageal squamous cell carcinomaMethods: We retrospectively analyzed clinical data of 147 patients with Ivor-Lewis esophagectomy approach by one ward of thoracic surgery department in Sichuan Cancer Hospital from June 2013 to October 2016.All the147 patients were divided into two groups according to different surgical approach,including 65 patients who underwent MIE-Ivor-Lewis approach and82 patients underwent Open Ivor-Lewis Esophagectomy(ILE approach).Perioperative outcomes and the incidence of postoperative complications,postoperative pain score and survival rate were compared two groups.Results: These demographic characteristics,tumor staging,preoperative complications,intra-operative blood loss,the average number of lymph node harvest,postoperative extubation time,eating time,the rate of anastomoticleakage and the survival rate were similar between two groups.The operation time and the hospital cost of MIILE group was significantly more than that of ILE group(289.6±32.3min vs.260.8±26.3 min,P<0.001,88030.9±8578.3yuan vs.80852.4±6014.3yuan,P<0.001,respectively),but shorter postoperative hospital stay was showed in MIILE group(11.5±3.6d vs.13.0±4.5d,P=0.005).The incidence of recurrent laryngeal nerve injury/paralysis and pulmonary infection in MIILE group was lower than that in ILE group(4.6% vs.14.6%,P=0.046,15.4% vs.34.1%,P=0.013,respectively),and the NRS pain scores of postoperative 24 h,48h,72 h and 1month were lower in MIILE group(3.1±0.8 vs.4.2±0.9,3.9±0.9 vs.4.7±1.0,3.4±0.8 vs.4.6±0.9,2.7±0.7 vs.3.5±1.2,P<0.001).Conclusions: This study initially showed that the MIILE procedure is safe and feasible.In MIILE group,the operation time was longer,the hospitalization cost was higher,but,there have some advantages in hospital stay,incidence of recurrent laryngeal nerve injury/ paralysis and pulmonary infection.Therefore,MIILE approach can be considered as the first choice for the patients of the middle and lower thoracic esophageal carcinoma before IIIA stage,who without cervical lymph node metastasis.