A Case-Control Study on the Therapeutic Effect of Mediastinoscope-Assisted and Thoracoscope-Assisted Esophagectomy

Abstract

Objective. To compare the clinical efficacies of mediastinoscope-assisted and thoracoscope-assisted esophagectomy. Materials and Methods. Seventy-six patients with esophageal cancer who underwent minimally invasive esophagectomy at the General Hospital of Ningxia Medical University between June 2015 and January 2019 were retrospectively evaluated. Among them, 28 patients underwent mediastinoscope-assisted transhiatal esophagectomy (MATHE), and 48 received thoracoscope-assisted transthoracic esophagectomy (TATTE). The perioperative clinical data and follow-up data of the 2 groups were compared. Results. All operations were successful in both groups. MATHE was favorable in terms of operation time, intraoperative blood loss, drainage volume 3 days after surgery, postoperative hospital stay, and hypoproteinemia ( P < .05). Lymph node dissections were less than those in the TATTE ( P < .05). No significant differences in long-term postoperative complications and survival rate were found between the 2 groups ( P > .05). Conclusion. MATHE has the advantages of minimal trauma, shorter operation time, less intraoperative blood loss, and faster recovery. More adequate tumor clearance in terms of lymph node dissection can be achieved with TATTE. However, the comparison of survival rates between the 2 groups is similar.

Safety and Feasibility of Mediastinoscopy-assisted Esophagectomy: A Meta-analysis

“…In total, 15 studies 3,5–14,16–19 reported postoperative pulmonary complications in patients with esophageal cancer, and the results presented that the incidence of postoperative pulmonary complications in the MAE group was lower than in the TTE group (OR=0.60, 95% CI, 0.43 to 0.83, P =0.002) (Fig. 2A).…”

“…In total, 12 studies 5–13,15–17 reported the incidence of postoperative chylothorax, and the results presented that the incidence of chylothorax was not statistically different between the MAE group and the TTE group. (OR=0.62, 95% CI, 0.29 to 1.32, P =0.21) (Fig.…”

“…The number of lymph nodes dissected during the operation was reported in 7 studies, 3,5,7,8,12,13,16 with significant heterogeneity between data (I 2 = 92%, P < 0.00001). Comparing the operation method shows that in Ma et al 7 and Li et al 13 studies, the MAE group used left thoracotomy in the bottom of the esophagus and stomach free and lymph node excision, while in the rest of the studies, the MAE group used abdominal free of esophagus and stomach.…”

Clinical-pathological features and perioperative outcomes of mediastinoscopy vs. thoracoscopy esophagectomy in esophageal cancer: A meta-analysis

“…Then 166 records were immediately excluded by screening the titles and abstracts. We read the full text of the remaining 19 studies carefully, and 8 studies meeting our criteria were finally considered eligible in this meta-analysis ( 18 – 25 ). The flow chart of the literature evaluation process in our meta-analysis is presented in Figure 1 .…”

“…Quality assessment results of the observational studies were depicted in Table 1 and the summary figure of the RCT was depicted in Figure 2 . Four out of the seven observational studies were ranked with medium quality ( 18 , 20 , 22 , 24 ), while the other three were ranked with high quality ( 19 , 21 , 25 ) ( Table 1 ). The RCT arose some concerns regarding the risk of bias ( 23 ).…”