Survival outcomes of 220 consecutive patients with three-staged thoracoscopic esophagectomy

Abstract

Patients with thoracic esophageal cancer are often treated by minimally invasive esophagectomy. However, the long-term survival benefits of minimally invasive esophagectomy remain unclear. Two approaches are available for thoracoscopic surgery: one with the patient in the left lateral decubitus position (LLDP), and the other with the patient in the prone position (PP). We investigated the survival benefit of thoracoscopic esophagectomy according to the tumor stage and patient position during the thoracoscopic procedure. We reviewed the records of 220 consecutive patients with esophageal cancer treated from 1998 to 2012. In total, 146 and 74 patients were treated with thoracoscopic esophagectomy in the LLDP and PP, respectively. No patients were initially proposed to be candidates for esophagectomy by thoracotomy during the study period. Data collection was performed with a focus on survival and recurrent disease. Among all the 220 patients, the overall 5-year survival rates were 83.7%, 74.1%, 45.5%, 78.6%, 44.2%, 29.4% and 24.3% in the patients with pStage IA, IB, IIA, IIB, IIIA, IIIB and IIIC disease, respectively. Despite the greater number of dissected mediastinal lymph nodes in the PP procedure, there were no significant differences in the survival curves between the LLDP and PP procedures. The long-term results of thoracoscopic esophagectomy are comparable and acceptable. The PP procedure was not confirmed to offer a superior survival benefit to the LLDP procedure in this retrospective study.

Three-Month and Three-Year Survival Rates and Complications of Transthoracic Surgery in Patients with Esophageal Cancer at Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences

“…In a similar study, the 5-year survival rate was 52% in transthoracic approach (10). Another similar study showed that 5-year survival rate based on the staging of the tumor, varied from 24% to 84% in patients who had surgical thoracoscopy (12). In a similar study in Mashhad, Iran, 5-year survival rate of patients with esophageal squamous cancer was 48%.9.…”

The surgical outcome of minimally invasive pharyngo-laryngo-oesophagectomy in prone position

“…As for ensuring of the operative field, it is advantageous for pressing down the trachea by using a single-lumen flexible endotracheal tube. In their study, Noshiro et al [3] reported that blood loss was significantly lower and the number of retrieved lymph nodes was more in the PP group than in LLDP group. A possible reason for lower blood loss in the PP group may include the better visual field, and easer manoeuvrability caused by the artificial pneumothorax and the bleeding reduction effect due to the pressure of the pneumothorax.…”

A case of Mirizzi syndrome that was successfully treated by laparoscopic choledochoplasty using a gallbladder patch

“…Laparoscopic surgery for Mirizzi syndrome is reported to be associated with a high risk of conversion to open surgery (41%), complications (16%) and reoperation (5%) [ 6 ]. However, in recent years, laparoscopic surgery has steadily progressed and advanced techniques have been applied in the treatment of various types of disease [ 8 ]. Laparoscopic subtotal cholecystectomy, with the extraction of impacted stones has been reported to be successful in cases of Mirizzi syndrome [ 4 , 6 , 9 ].…”