Comparison of the outcomes between thoracoscopic and laparoscopic esophagectomy via retrosternal and prevertebral lifting paths by the same surgeon

Abstract

BackgroundThe objective of the study is to explore the effects of retrosternal and prevertebral lifting paths of the tubular stomach on postoperative complications of patients undergoing cervical anastomosis in thoracoscopic and laparoscopic esophagectomy.MethodsSixty-three patients were retrospectively analyzed. The patients received thoracoscopic and laparoscopic esophagectomy by the same surgeon. According to the path by which the stomach was lifted upward, the patients were divided into two groups: the retrosternal path group (32 patients) and the prevertebral path group (31 patients). Operative indications and complications of postoperative patients in these two groups were observed.ResultsThere was no statistically significant difference in the time duration of surgery, amount of bleeding, number of dissected lymph node, and postoperative hospitalization time between the retrosternal and prevertebral lifting paths (P > 0.05). Furthermore, the two groups did not show significant difference in the incidence rate of postoperative anastomosis fistula complications (P = 0.702). Instead, the amount of postoperative gastric drainage and the incidence rates of the pulmonary infection were significantly lower in the retrosternal path group than in the prevertebral path group, respectively (P = 0.001, P = 0.012, respectively).ConclusionThe esophagogastrostomic cervical anastomoses performed via the retrosternal and prevertebral paths are both feasible methods of digestive tract reconstruction. The amount of postoperative gastric drainage volume and the pulmonary infection incidence rate in the retrosternal path group were lower than those in the prevertebral path group. Therefore, gastroesophageal anastomosis via the retrosternal lifting path may be preferably considered for thoracoscopic and laparoscopic surgery for esophageal carcinoma patients.

Development and validation of the Convalescence Symptom Assessment Scale for EsophageCtomy patients

“…Chest discomfort after eating is due to the particularity of oesophageal cancer surgery. During the operation, a tubular stomach needs to be made, and the stomach is lifted from the abdominal cavity to the chest cavity (Liu et al., 2017 ; Lv et al., 2017 ). Therefore, patients may experience chest tightness and shortness of breath after eating.…”

Comparison of substernal and posterior mediastinal route of reconstruction after minimally invasive esophagectomy for esophageal cancer

“…Previously, due to its higher morbidity rates including pulmonary complication and anastomotic leakage, the ST route has not been a favorable choice and only considered as an altenative when PM route was not available [15,25]. However, recent studies demonstrated that the ST route had comparable safety and e cacy to the PM route, and thus became a frequent approach for reconstruction after MIE in many centers [8,11,14,16].…”

“…In the other hand, gastric conduit placed in the ST route would not be affected by mediastinal recurrence or radiation therapy [8,9]. Moreover, reconstruction through the ST route might help avoid some severe complications such as airway-gastric conduit stula [10], hiatal and para-conduit hernia [11,12], and it might reduce incidences of gastroesophageal re ux [13], and pulmonary complications, particularly pneumonia compared with the PM route [14]. Meanwhile some prior studies showed a lower anastomotic leakage rate using PM route [15][16][17][18], the others revealed similar rates of anastomotic leakage between the two groups [11,19].…”

The Complications between Different Routes of Reconstruction after Esophagectomy

“…Taken together, given the minimal interference with lung function, RS route represents a preferred choice for the patients particularly with poor pulmonary function. 19 Many patients suffering from esophageal carcinoma were already at later stage of disease by their first clinical presentation. The structure of esophagus in those patients was occupied by the tumor mass that was prone to invasively grow and often caused local recurrence after surgery.…”