Comparative Study On Therapeutic Effects Of Minimally Invasive Esophagectomy Versus Open Esophagectomy

ObjectiveTo compare the therapeutic effects between minimally invasive esophagectomy and open esophagectomy.MethodsThe retrospective case-control study was conducted.The clinicopathological date of 454 EC patients who underwent minimally invasive esophagectomy(MIE: 229 cases)or open esophagectomy(OE: 225 cases)in the Tianjin Medical University Cancer Institute and Hospital from January 2012 to September 2016 were collected.Observation indicators:1.Surgical situations: operation time,intraoperative blood loss,the number of lymph node dissection.2.Post-operative recovery situations: thoracic drainage tube placement time,the drainage fluid,the rate of total postoperative complications,pneumonia,recurrent laryngeal nerve paralysis,arrhythmia,chylothorax,anastomotic stenosis,anastomotic fistula,respiratory failure,pulmonary embolism,and died within 30 days after surgery.3.Hierarchical analysis: For MIE group,93 of them underwent surgery within the physician's learning curve,and 136 of them were underwent surgery after the doctors had passed the learning curve.The surgical conditions,postoperative complications and others were collected and analyzed between the two groups.4.Follow-up and survival situations: Follow-up using outpatient examination and telephone interview was performed to detect the post-operative survival of patients up to October 2017.The 3-year survival rate(patients who underwent surgical treatment before October 2014)were collected and analyzed between the two groups.Results1.Surgical situations: MIE group's operation time,upper mediastina lymph nodes of TNM stage 0 ~ II,right laryngeal nerve lymph node of TNM stage 0 ~ II were respectively(307±70)min,4(range,0-18),2(range,0-10),while the OE group's were respectively(267±49)min,3(range,0-15),1(range,0-7).The comparison between the two groups was statistically significant(t=7.071,Z=-2.207,-2.717,P < 0.05).2.Post-operative recovery situations: The thoracic drainage tube placement time and the drainage fluid between MIE and OE were 5d(2-88d)and 8d(1-72d),280mL(0-7792ml)and 1650mL(225-7970ml)respectively,the difference was statistically significant(Z=-9.618,-15.443,P<0.05).The total postoperative complications,arrhythmia and recurrent laryngeal nerve paralysis were 72,20 and 35 cases respectively of MIE group,as 100,36,56 cases for OE group,the difference was statistically significant(?2=8.155,5.542,6.533,P<0.05).Multiple complications can be combined with the same patient.3.Hierarchical analysis: The difference in the number of upper mediastina lymph nodes between the two indexes were 3(range,0-20)and 4(range,0-37),the difference was statistically significant(Z=-2.472,P<0.05).The other indexes showed no statistically significant difference.4.Follow-up and survival situations: of 187 patients,162 cases(77 for MIE,85 for OE)were followed up for 1-62 months,with a median time of 36 months.the cumulative survival rate of the MIE group and the OE group was 68.1% and 53.8%,respectively.There was no statistically significant difference between them(?2=2.664,0.382,P>0.05).ConclusionMinimally invasive esophagectomy has the same oncology resection effects and 3-year survival rate as open esophagectomy,and decreases postoperative complications,which has a large clinical value.