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Minimally invasive esophagectomy for esophageal squamous cell carcinoma: a case–control study of thoracoscope versus mediastinoscope assistance

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Abstract

Objective

Minimally invasive esophagectomy (MIE) has been widely applied for esophageal carcinoma treatment. Thoracoscope-assisted transthoracic esophagectomy (TATTE) and mediastinoscope-assisted transhiatal esophagectomy (MATHE) are two kinds of MIE. The objective of this study is to compare these two methods with respect to surgical safety and survival.

Methods

Single-institution experience with MATHE and TATTE was analyzed to assess morbidity, adequacy of tumor clearance, and survival. A pair-matched case–control study was performed to compare 54 patients who underwent either MATHE or TATTE between July 2000 and December 2009. Patients were matched by age, sex, comorbidity, forced expiratory volume in 1 s (FEV1), tumor location, and stage.

Results

Statistically significant differences between the MATHE group and the TATTE group were: shorter operative time for MATHE (194.4 min) versus TATTE (228.1 min), less blood loss during operation in the TATTE group (142.6 ml) versus the MATHE group (214.6 ml), and more lymph nodes retrieved in the TATTE group (19.1 nodes) versus the MATHE group (11.4 nodes). There was no difference in survival between the groups.

Conclusions

MATHE and TATTE are both technically feasible. TATTE can provide better visibility. TATTE has less blood loss compared with MATHE. More adequate tumor clearance in terms of lymph node dissection can be achieved with TATTE.

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References

  1. Birkmeyer JD, Siewers AE, Finlayson EVA, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346:1128–1137

    Article  PubMed  Google Scholar 

  2. Orringer MB, Sloan H (1978) Esophagectomy without thoracotomy. J Thorac Cardiovasc Surg 76:643–654

    PubMed  CAS  Google Scholar 

  3. Waller DA, Forty J, Morritt GN (1994) Video-assisted thoracoscopic surgery versus thoracotomy for spontaneous pneumothorax. Ann Thorac Surg 58:372–376

    Article  PubMed  CAS  Google Scholar 

  4. Santambrogio L, Nosotti M, Bellaviti N, Mezzetti M (1995) Videothoracoscopy versus thoracotomy for the diagnosis of the indeterminate solitary pulmonary nodule. Ann Thorac Surg 59:868–870

    Article  PubMed  CAS  Google Scholar 

  5. Akaishi T, Kaneda I, Higuchi N (1996) Thoracoscopic en bloc total esophagectomy with radical mediastinal lymphadenectomy. J Thorac Cardiovasc Surg 112:1534–1541

    Article  Google Scholar 

  6. Luketich J, Alvelo-Rivera M, Buenaventura P, Christie NA, McCaughan JS, Litle VR, Schauer PR, Close JM, Fernando HC (2003) Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg 238:486–495

    PubMed  Google Scholar 

  7. Law S, Fok M, Chu KM, Wong J (1997) Thoracoscopic esophagectomy for esophageal cancer. Surgery 122:8–14

    Article  PubMed  CAS  Google Scholar 

  8. Nguyen NT, Schauer PR, Luketich JD (1999) Combined laparoscopic and thoracoscopic approach to esophagectomy. J Am Coll Surg 188:328–332

    Article  PubMed  CAS  Google Scholar 

  9. Bumm R, Holscher AH, Feussner H, Tachibana M, Bartels H, Siewert JR (1993) Endodissection of the thoracic esophagus. Technique and clinical results in transhiatal esophagectomy. Ann Surg 218:97–104

    Article  PubMed  CAS  Google Scholar 

  10. Bumm R, Feussner H, Bartels H, Stein H, Dittler HJ, Höfler H, Siewert JR (1997) Radical transhiatal esophagectomy with two-field lymphadenectomy and endodissection for distal esophageal adenocarcinoma. World J Surg 21:822–831

    PubMed  CAS  Google Scholar 

  11. Tangoku A, Yoshino S, Abe T, Hayashi H, Satou T, Ueno T, Oka M (2004) Mediastinoscope-assisted transhiatal esophagectomy for esophageal cancer. Surg Endosc 18:383–389

    Article  PubMed  CAS  Google Scholar 

  12. Wang H, Feng MX, Tan LJ, Wang Q (2010) Comparison of the short-term quality of life in patients with esophageal cancer after subtotal esophagectomy via video-assisted thoracoscopic or open surgery. Dis Esophagus 23(5):408–414

    PubMed  Google Scholar 

  13. Jacobi CA, Zieren HU, Muller JM, Pichlmaier H (1997) Surgical therapy of esophageal carcinoma: the influence of surgical approach and esophageal resection on cardiopulmonary function. Eur J Cardiothorac Surg 11:32–37

    Article  PubMed  CAS  Google Scholar 

  14. Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BPL, Tijssen GP, Fockens P, Stalmeier PFM, TEN Kate FJW, Dekken HV, Obertop H, Tilanus HW, van Lanschot (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347:1662–1669

    Article  PubMed  Google Scholar 

  15. Omloo JM, Lagarde SM, JBr Hulsche, Reitsma JB, Fockens P, van Dekken H, ten Kate FJW, Obertop H, Tilanus HW, van Lanschot JB (2007) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus. Five-year survival of a randomized clinical trial. Ann Surg 246:992–1001

    Article  PubMed  Google Scholar 

  16. Chu KM, Law SY, Fok M, Wong J (1997) A prospective randomized comparison of transhiatal and a transthoracic resection for lower-third esophageal carcinoma. Am J Surg 174:320–324

    Article  PubMed  CAS  Google Scholar 

  17. Goldminc M, Maddern G, Le Prise E, Meunier B, Campion JP, Launois B (1993) Oesophagectomy by a transhiatal approach or thoracotomy: a prospective randomized trial. Br J Surg 80:367–370

    Article  PubMed  CAS  Google Scholar 

  18. Smithers BM, Gotley DC, Thomas JM (2007) Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg 245:232–240

    Article  PubMed  Google Scholar 

  19. OrringerMB MarshallB, Chang AC, Pickens A, Lau CL (2007) Two thousand transhiatal esophagectomies. Changing trends, lessons learned. Ann Surg 246:363–374

    Article  Google Scholar 

  20. Palanivelu C, Prakash A, Senthilkumar R, Senthilnathan P, Parthasarathi R, Rajan PS, Venkatachlam S (2006) Minimally invasive esophagectomy: thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position—experience of 130 patients. J Am Coll Surg 203:7–16

    Article  PubMed  Google Scholar 

  21. Yamamoto S, Kawahara K, Maekawa T, Shiraishi T, Shirakusa T (2005) Minimally invasive esophagectomy for stage I and II esophageal cancer. Ann Thorac Surg 80:2070–2075

    Article  PubMed  Google Scholar 

  22. Nguyen NT, Hinojosa MW, Smith BR, Chang KJ, Gray J, Hoyt D (2008) Minimally invasive esophagectomy. Lessons learned from 104 operations. Ann Surg 248:1081–1091

    Article  PubMed  Google Scholar 

  23. Zingg U, McQuinn A, Physio B, DiValentino D, Esterman AJ, Bessell JR, Thompson SK, Jamieson GG, Watson DI (2009) Minimally invasive versus open esophagectomy for patients with esophageal cancer. Ann Thorac Surg 87:911–919

    Google Scholar 

  24. Martin DJ, Bessell JR, Chew A, Watson DI (2005) Thoracoscopic and laparoscopic esophagectomy. Initial experience and outcomes. Surg Endosc 19:1597–1601

    Article  PubMed  CAS  Google Scholar 

  25. Karl RC, Schreiber R, Boulware D, Baker S, Coppola D (2000) Factors affecting morbidity, mortality, and survival in patients undergoing Ivor Lewis esophagogastrectomy. Ann Surg 231:635–643

    Article  PubMed  CAS  Google Scholar 

  26. Hulscher JB, van Sandick JW, Devriese PP, van Lanschot JJ, Obertop H (1999) Vocal cord paralysis after subtotal oesophagectomy. Br J Surg 86:1583–1587

    Article  PubMed  CAS  Google Scholar 

  27. Greenstein AJ, Litle VR, Swanson SJ, Divino CM, Packer S, Wisnivesky JP (2008) Effect of the number of lymph nodes sampled on postoperative survival of lymph node-negative esophageal cancer. Cancer 112:1239–1246

    Article  PubMed  Google Scholar 

  28. Peyre CG, Hagen JA, DeMeester SR, Altorki NK, Ancona E, Griffin SM, Holscher A, Lerut T, Law S, Rice TW, Ruol A, van Lanschot JJB, Wong J, DeMeester TR (2008) The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg 248:549–556

    Article  PubMed  Google Scholar 

  29. Altorki NK, Zhou XK, Stiles B, Port JL, Paul S, Lee PC, Mazumdar M (2008) Total number of resected lymph nodes predicts survival in esophageal cancer. Ann Surg 248:221–226

    Article  PubMed  Google Scholar 

  30. Block MI (2006) Transthoracic vs transhiatal esophagectomy: stage migration muddies the water. J Surg Oncol 93(7):519–520

    Article  PubMed  Google Scholar 

  31. Metze K (2009) The association between overall survival and the total number of dissected lymph nodes: An artifact caused by the surgical pathologist? Ann Surg 249:693–694

    Article  PubMed  Google Scholar 

  32. Horstmann O, Verreet PR, Becker H, Ohmann C, Röher HD (1995) Transhiatal oesophagectomy compared with transthoracic resection and systematic lymphadenectomy for the treatment of esophageal cancer. Eur J Surg 161:557–567

    PubMed  CAS  Google Scholar 

  33. Lerut T, Coosemans W, De Leyn P, Deneffe G, Topal B, Van de Ven C, Van Raemdonck D (1999) Reflections on three field lymphadenectomy in carcinoma of the esophagus and gastroesophageal junction. Hepatogastroenterology 46:717–725

    PubMed  CAS  Google Scholar 

  34. Dresner SM, Griffin SM (2000) Pattern of recurrence following radical oesophagectomy with two field lymphadenectomy. Br J Surg 87:1426–1433

    Article  PubMed  CAS  Google Scholar 

  35. Chang AC, Ji H, Birkmeyer NJ, Orringer MB, Birkmeyer JD (2008) Outcomes after transhiatal and transthoracic esophagectomy for cancer. Ann Thorac Surg 85:424–429

    Article  PubMed  Google Scholar 

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Disclosures

Authors Feng ming-xiang, Wang hao, Zhang yi, Tan li-jie, Xu zheng-lang, and Wang qun have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenlin Road, Shanghai, 200032, China

    Ming-Xiang Feng, Hao Wang, Yi Zhang, Li-Jie Tan, Zheng-Lang Xu & Wang Qun

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  1. Ming-Xiang Feng
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  2. Hao Wang
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  3. Yi Zhang
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Correspondence to Li-Jie Tan.

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Feng, MX., Wang, H., Zhang, Y. et al. Minimally invasive esophagectomy for esophageal squamous cell carcinoma: a case–control study of thoracoscope versus mediastinoscope assistance. Surg Endosc 26, 1573–1578 (2012). https://doi.org/10.1007/s00464-011-2073-7

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  • DOI: https://doi.org/10.1007/s00464-011-2073-7

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