A Comparative Study Of Minimally Invasive Mckeown Esophageal Carcinoma Radical Surgery And Cervical-thoracic-abdominal Three-intraoperative Esophageal Carcinoma Radical Surgery

Objectives:Through comparative analysis of two groups of patients under different surgical methods of intraoperative situation,postoperative results and the incidence of postoperative complications,then to explore the advantages and disadvantages as well as clinical application value of radical surgery of minimally invasive esophageal cancer compared with the traditional cervical-thoracic-abdominal triple incision esophageal cancer radical surgery,to further verify the surgical safety,feasibility and thoroughness in the treatment of esophageal cancer.Methods:Retrospective analysis of the data of patients undergoing esophageal cancer radical resection at the Department of Thoracic Surgery of the Second Affiliated Hospital of Kunming Medical University from August 2010 to August 2017,a total of 86 cases were selected according to the inclusion criteria.According to the different surgical methods,42 cases were divided into minimally invasive surgery group and 44 cases were divided into open three-incision surgery group.Compare the general data of the two groups of patients,the intraoperative conditions,postoperative results and the incidence of postoperative complications.Results:(1)There was no significant difference in the age structure,gender composition,and preoperative combined basic disease between the two groups(P>0.05).The clinical data were comparable.(2)42 patients in the minimally invasive surgery group completed the operation successfully,and no conversion to thoracotomy was performed.No secondary surgery was used to stop the bleeding.Two patients died during the postoperative perioperative period.44 patients in the open three-incision surgery group completed the operation successfully,and one of the patients had undergone a second operation to open the chest to stop bleeding due to postoperative bleeding.Three patients died during the postoperative perioperative period.(3)Comparison of intraoperative conditions:The operative time(Min)in the minimally invasive surgery group was significantly more than that in the open three-incision group(460.71 ±94.60 VS 358.64±91.26).The difference between the groups was statistically significant(P<0.05).The intraoperative blood loss(ml)in the minimally invasive surgery group was significantly lower than that in the open three incision surgery group(322.62± 132.10 VS 527.50± 177.28),and the difference between the groups was statistically significant(P<0.05).There was no significant difference in the total number of lymph node dissections between the two surgical procedures(15.64 ± 5.10 VS 15.45 ± 3.89)(P>0.05).(4)Comparison of postoperative results:pleural drainage on the first postoperative day(ml)(274.05 ± 112.25 VS 381.70 ± 117.42)and postoperative chest tube retention time(d)(8.88 ± 2.32 VS 11.82 ± 2.48)、postoperative intensive care unit of thoracic surgery(d)(7.62 ±2.93 VS 10.36±3.37)and postoperative hospital stay(d)(17.40±4.87 VS 25.05±6.60)were significantly less than open three-incision surgery groups.The difference was statistically significant(P<0.05).(5)Postoperative complications:The incidence of postoperative complications in the minimally invasive surgery group was significantly lower than that in the open three-incision group(26.2%VS 47.7%),and the difference between the groups was statistically significant(P<0.05).Regarding the incidence of single complications,the incidence of pulmonary infection in the minimally invasive surgery group(14.3%VS 36.4%)、pleural effusion(9.52%VS 27.3%)、incision infection(2.4%VS 20.5%)and need for ventilator support(4.8%VS 20.5%)were significantly lower than those in the open three-incision group,the difference between the two groups was statistically significant(P<0.05).However,there was no significant difference in the incidence of postoperative complications such as pneumothorax,arrhythmia,anastomotic leakage,anastomotic stenosis,hoarseness,chylothorax,and delayed gastric emptying(P>0.05).Conclusions:(1)Although minimally invasive Mckeown’s radical surgery for esophageal cancer is difficult and the learning curve is long,the long-term survival rate remains to be further studied.However,minimally invasive Mckeeown esophageal cancer radical surgery has the advantages of less surgical trauma,less intraoperative blood loss,less postoperative pain,quicker recovery,and shorter postoperative hospital stay than open radical triple incision esophagectomy,In addition,patients who are older and whose lung function cannot tolerate open triple incision esophagectomy can get surgery.(2)Compared with open radical incision esophagectomy,minimally invasive Mckeeown esophageal carcinoma has fewer chest drainage fluids,chest tube placement time,and postoperative intensive care unit monitoring time after radical surgery.(3)The ability and scope of lymph node dissection for minimally invasive surgery can reach or even exceed the effect of open lymph node dissection,thus better ensuring the thoroughness of esophageal cancer radical resection.(4)The incidence of total complications after minimally invasive Mckeown’s radical resection of esophageal cancer was lower,especially in the incidence of postoperative pulmonary infection,pleural effusion,incision infection and the need for ventilator-assisted ventilation compared with the open three-incision group.In addition,this study further confirms that minimally invasive surgery is safe,thorough,and effective in the eradication of esophageal cancer and lymph node dissection,and is worthy of extensive clinical application and promotion.As with the success of thoracoscopic radical surgery for lung cancer,minimally invasive Mckeeown esophageal cancer radical surgery will gradually become the mainstream of esophageal cancer radical surgery.