Comparison of transhiatal esophagectomy using a mediastinoscope with transhiatal esophagectomy by the classic method

Abstract

Background This study aimed to evaluate the results of transhiatal esophagectomy using a mediastinoscope in comparison with conventional transhiatal esophagectomy. Methods Sixty-two esophageal cancer patients who were referred to our thoracic surgery clinic between April 2015 and March 2017, and met the inclusion criteria, were randomly divided into two groups of 31 each. In the first group, patients were operated on by conventional transhiatal esophagectomy. In the second group, only release of the thoracic esophagus through a neck incision (mediastinal esophagolysis) was performed using a mediastinoscope. The other surgical procedures were similar to those in the first group. Results The mean age of the patients was almost the same in both groups (57.7 years in the first group versus 56.7 years in the second group). There was no significant difference in sex ratio. The mean volume of blood loss during the operation, mean operative time, and intensive care unit stay as well as cardiopulmonary complications and early postoperative complications were lower in the group that had esophagectomy using a mediastinoscope, and the number of resected mediastinal lymph nodes was greater. Conclusion Based on the results of this study, it can be expected that use of a video mediastinoscope for esophagolysis of the thoracic esophagus in a transhiatal esophagectomy procedure is safe and it will reduce the morbidity and mortality in these patients.

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

“…A total of 10 studies 5,6,9–12,15,17–19 reported cardiac complications after esophageal cancer surgery, the findings indicated that the incidence of cardiac complications after surgery in the MAE group was lower than the TTE group (OR=0.57, 95% CI, 0.34 to 0.94, P =0.03) (Fig. 2B).…”

“…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).…”

“…Postoperative mortality was reported in 6 studies, 3,6,13,15,16,19 and the results showed that the postoperative mortality was not statistically different between the MAE group and the TTE group (OR = 0.84, 95% CI, 0.30 to 2.33, P = 0.74) (Fig. 4B).…”

Outcomes of Minimally Invasive and Robot-Assisted Esophagectomy for Esophageal Cancer

“…While transhiatal MIE gained initial traction, concerns began to grow regarding long-term survival rates, and this technique was largely replaced by the McKeown and Ivor Lewis techniques [ 2 , 47 ]. Recent studies do exist, however, that use techniques such as mediastinoscopy to reassess safety and efficacy of minimally invasive transhiatal esophagectomy [ 48 , 49 ].…”

Approach to Localized Squamous Cell Cancer of the Esophagus

“…The mean volume of blood loss during the operation, mean operative time, intensive care unit stay, cardiopulmonary complications, and early postoperative complications were lower in the mediastinoscope group, and the number of resected mediastinal lymph nodes was greater. The results of this small study indicate that video mediastinoscope-assisted esophagolysis with trans-hiatal esophagectomy is safe and may reduce morbidity and mortality in ESCC patients [ 30 ]. Another risk of esophagectomy is complications from esophageal reconstruction.…”