Video-assisted McKeown esophagectomy for esophageal cancer: 18-year experience in a single institution

doi:10.3877/cma.j.issn.2095-8773.2016.01.007

Abstract

Abstract:

Objective

To summarize the 18-year experience in video-assisted McKeown esophagectomy for esophageal cancer.

Methods

The clinical data of 639patients with esophageal cancer undergoing McKeown esophagectomy between August 1997 and June 2015 in Department of Thoracic Surgery, Taizhou Hospital affiliated to Wenzhou Medical University were retrospectively analyzed. Among these 639 patients, 622(97.34%) completed the surgery with video-assisted procedures. A total of 7.98% of esophageal tumors located in the upper segment, 63.54% in the middle segment, and 28.48% in the lower segment.Preoperative neoadjuvant chemoradiotherapy was done in 8.92% of patients. For TNM staging, stage 0 accounted for 10.33%, stage Ⅰ29.26%, stage Ⅱ 42.10%, stage Ⅲ15.02% and stage Ⅳ 3.29%. Pathological examinations demonstrated that there were 92.02% of squamous cancer and 7.98% of adenocarcinoma and other histological types.Surgery were completed by thoracoscopy and laparotomy(44.60%), thoracoscopy and laparoscopy(47.26%), thoracotomy and laparoscopy(5.48%), and conversion to thoracotomy or laparotomy (2.66%).

Results

The time of esophagus freeing and pleural lymph node dissection under thoracoscope was (78.6±36.9)min, and the time of stomach freeing and abdominal lymph node dissection under laparoscope was (55.4±19.5) min. The volumes of blood loss in thoracoscopic surgery and laparoscopic surgery were (99.5±79.2) ml and (40.5±23.4) ml respectively. The mean total number of lymph node dissection was(24.1±12.4) per case, and the number of thoracic lymph node dissection was (14.9±8.1) per case, abdominal lymph node dissection (9.1±5.5) per case, and neck lymph node dissection (1.5±1.3) per case. There was no death during operation. There were 4 cases of intraoperative bleeding due to the azygos vein or spleen injury, 4 cases of accidental tracheal injury caused by cautery hook or ultrasound knife, 13 cases of thoracic duct injury of non-focal cause, 11 cases of atrial fibrillation and 4 cases of esophageal resection margin-positive R₁ resection. The major complications in the early postoperative period which occurred in more than 10 cases were lung infection(11.42%), neck anastomosis leak(7.04%), arrhythmia(4.85%), pleural effusion catheterization(3.29%), recurrent laryngeal nerve injury(3.13%) and chylothorax(2.03%). Six cases(0.94%) died early after operation. Among them, 3 died of postoperative respiratory failure, 1 severe pulmonary infection after tracheoesophageal fistula, 1 recurrent hyperglycemia complicated with neck anastomotic fistula uncured and multiple organ failure, and the other aorta rupture and bleeding caused by chest gastric fistula or necrosis. Three hundred and seven patients (48.04%) received postoperative radiotherapy and chemotherapy. The follow-up rate was 90.8%, and the mean follow-up time was (44.5 ± 33.1) months.The 1, 2, 3, and 5-year overall survival rates were 83.9%, 69.7%, 57.1%and 45.5%, respectively.

Conclusions

Video-assisted McKeown esophagectomy for esophageal cancer is feasible and effective in tumor R₀ resection and short-term and long-term effects.

Key words: Esophageal neoplasms, Thoracoscopy, Laparoscopy, Minimally-invasive surgery

Min Kong, Baofu Chen, Chunguo Wang, Bo Zhang, Jian Zhang, Dehua Ma, Minhua Ye, Zhongrui Ye, Chengchu Zhu. Video-assisted McKeown esophagectomy for esophageal cancer: 18-year experience in a single institution[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2016, 03(01): 7-14.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhxbwkdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-8773.2016.01.007

https://zhxbwkdzzz.cma-cmc.com.cn/EN/Y2016/V03/I01/7

Figures/Tables 6

References 26

[1]	TorreLA,BrayF,SiegelRL，et al. Global cancer statistics, 2012 [J]. CA Cancer J Clin, 2015, 65(2): 87-108.
[2]	McKeownKC.Total three-stage oesophagectomy for cancer of the oesophagus [J]. Br J Surg，1976, 63：259-262.
[3]	Japanese Society for Esophageal Diseases. Guidelines for clinical and pathologic studies on carcinoma of the esophagus, ninth edition: Preface, general principles, part Ⅰ [J]. Esophagus, 2004, 1(2): 61-88.
[4]	BiereSS,MaasKW,BonavinaL，et al. Traditional invasive vs. minimally invasive esophagectomy: a multi-center, randomized trial (TIME-trial) [J]. BMC Surg, 2011, 11：2.
[5]	BiereSS,van Berge HenegouwenMI,MaasKW，et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial [J]. Lancet, 2012, 379(9829): 1887-1892.
[6]	SwisherSG,DefordL,MerrimanKW, et al. Effect of operative volume on morbidity, mortality, and hospital use after esophagectomy for cancer [J]. J Thorac Cardiovasc Surg，2000, 119(6): 1126-1132.
[7]	BaileySH,BullDA,HarpoleDH，et al. Outcomes after esophagectomy: a ten-year prospective cohort [J]. Ann Thorac Surg，2003, 75(1): 217-222; discussion 22.
[8]	BirkmeyerJD,SiewersAE,FinlaysonEV，et al. Hospital volume and surgical mortality in the United States [J]. N Engl J Med，2002, 346(15): 1128-1137.
[9]	SabanathanS,MearnsAJ,RichardsonJ. Endoscopic oesophagectomy through a right thoracoscopic approach [J]. J R Coll Surg Edinb, 1992, 37(4)：284-285.
[10]	DePaulaAL,HashibaK,FerreiraEA，et al. Laparoscopic transhiatal esophagectomy with esophagogastroplasty[J]. Surg Laparosc Endosc, 1995, 5(1)：1-5.
[11]	LuketichJD，PennathurA,FranchettiY, et al. Minimally invasive esophagectomy: results of a prospective phase II multicenter trial-the eastern cooperative oncology group (E2202) study[J]. Ann Surg，2015 Apr；261(4)：702-707.
[12]	EdgeS,ByrdD,ComptonC, et al. AJCC cancer staging manual[M]. 7th ed. New York：Springer, 2010.
[13]	ChenB,ZhangB,ZhuC, et al. Modified McKeown minimally invasive esophagectomy for esophageal cancer: a 5-year retrospective study of 142 patients in a single institution [J]. PLoS One, 2013, 8(12): e82428.
[14]	D'AmicoTA. Mckeown esophagogastrectomy [J]. J Thorac Dis，2014，6(Suppl 3)：S322-S324.
[15]	PerryY,FernandoHC. Three-field minimally invasive esophagectomy: current results and technique [J]. J Thorac Cardiovasc Surg, 2012，144(3)：S63-S66.
[16]	KoyanagiK,OzawaS,TachimoriY. Minimally invasive esophagectomy performed with the patient in a prone position: a systematic review [J]．Surg Today，2016 ，46(3)：275-284.
[17]	PalaniveluC，PrakashA，SenthilkumarR，et al. Minimally invasive esophagectomy: thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position—experience of 130 patients [J]. J Am Coll Surg, 2006，203(1)：7-16.
[18]	BartelsH,ThorbanS,SiewertJR. Anterior versus posterior reconstruction after transhiatal oesophagectomy: a randomized controlled trial [J]. Br J Surg，1993, 80(9): 1141-1144.
[19]	UrschelJD,UrschelDM,MillerJD, et al. A meta-analysis of randomized controlled trials of route of reconstruction after esophagectomy for cancer [J]. Am J Surg，2001, 182(5): 470-475.
[20]	ChenH,LuJJ,ZhouJ, et al. Anterior versus posterior routes of reconstruction after esophagectomy: a comparative anatomic study [J]．Ann Thorac Surg，2009, 87(2): 400-404.
[21]	HuH,YeT,TanD, et al. Is anterior mediastinum route a shorter choice for esophageal reconstruction? A comparative anatomic study [J]. Eur J Cardiothorac Surg，2011 Dec；40(6)：1466-1469.
[22]	LuketichJD,Alvelo-RiveraM,BuenaventuraPO, et al. Minimally invasive esophagectomy: outcomes in 222 patients [J]．Ann Surg, 2003, 238(4): 486-494; discussion 94-95.
[23]	DantocM,CoxMR,EslickGD. Evidence to support the use of minimally invasive esophagectomy for esophageal cancer: a meta-analysis [J]. Arch Surg, 2012, 147(8): 768-76.
[24]	SinghRK,PhamTH,DiggsBS，et al. Minimally invasive esophagectomy provides equivalent oncologic outcomes to open esophagectomy for locally advanced (stage Ⅱ or Ⅲ) esophageal carcinoma [J]. Arch Surg, 2011, 146(6): 711-714.
[25]	van HagenP,HulshofMC,van LanschotJJ，et al. Preoperative chemoradiotherapy for esophageal or junctional cancer [J]. N Engl J Med，2012，366(22)：2074-2084.
[26]	马雅婷，连士勇，刘志才，等．河南省林州市食管癌人群现时生存分析[J]. 中华预防医学杂志，2009, 43(12): 1100-1104.

指标		例数	比例或范围
年龄(岁)		61.3±10.4	34～83
性别		?	?
?	男性	431	67.45%
?	女性	208	32.55%
肿瘤部位		?	?
?	上段	51	7.98%
?	中段	406	63.54%
?	下段	182	28.48%
病理分期		?	?
?	0期	66	10.33%
?	Ⅰ期	187	29.26%
?	Ⅱ期	269	42.10%
?	Ⅲ期	96	15.02%
?	Ⅳa期	21	3.29%
病理类型		?	?
?	鳞癌	588	92.02%
?	腺癌或其他	51	7.98%
术前放化疗		57	8.92%

指标		例数	比例或范围
年龄(岁)		61.3±10.4	34～83
性别		?	?
?	男性	431	67.45%
?	女性	208	32.55%
肿瘤部位		?	?
?	上段	51	7.98%
?	中段	406	63.54%
?	下段	182	28.48%
病理分期		?	?
?	0期	66	10.33%
?	Ⅰ期	187	29.26%
?	Ⅱ期	269	42.10%
?	Ⅲ期	96	15.02%
?	Ⅳa期	21	3.29%
病理类型		?	?
?	鳞癌	588	92.02%
?	腺癌或其他	51	7.98%
术前放化疗		57	8.92%

指标		例数或(±s)	比例或范围
手术方式		?	?
?	胸腔镜＋开腹	285	44.60%
?	腹腔镜＋开胸	35	5.48%
?	胸腔镜＋腹腔镜	302	47.26%
?	中转开胸/开腹	17	2.66%
腔镜手术时间(min)		?	?
?	胸腔镜	78.6±36.9	45～180
?	腹腔镜	55.4±19.5	30～105
食管重建径路		?	?
?	食管床	275	43.04%
?	胸骨后	364	56.96%
出血量(ml)		?	?
?	胸腔镜	99.5±79.2	50～1 080
?	腹腔镜	40.5±23.4	30～350
淋巴结清扫数目(枚)		?	?
?	胸腔	14.9±8.1	3～32
?	腹腔	9.1±5.5	2～29
?	颈区	1.5±1.3	0～8
?	总数	24.1±12.4	5～48

指标		例数或(±s)	比例或范围
手术方式		?	?
?	胸腔镜＋开腹	285	44.60%
?	腹腔镜＋开胸	35	5.48%
?	胸腔镜＋腹腔镜	302	47.26%
?	中转开胸/开腹	17	2.66%
腔镜手术时间(min)		?	?
?	胸腔镜	78.6±36.9	45～180
?	腹腔镜	55.4±19.5	30～105
食管重建径路		?	?
?	食管床	275	43.04%
?	胸骨后	364	56.96%
出血量(ml)		?	?
?	胸腔镜	99.5±79.2	50～1 080
?	腹腔镜	40.5±23.4	30～350
淋巴结清扫数目(枚)		?	?
?	胸腔	14.9±8.1	3～32
?	腹腔	9.1±5.5	2～29
?	颈区	1.5±1.3	0～8
?	总数	24.1±12.4	5～48

并发症		例数	比例(%)
消化系统		?	?
?	颈部吻合瘘	45	7.04
?	气管食管瘘	2	0.31
?	胸胃瘘或坏死	2	0.31
?	胸胃扩张或胃排空障碍	7	1.10
?	膈疝	1	0.16
呼吸系统		?	?
?	肺部感染	73	11.42
?	咳痰无力需要纤维支气管镜吸痰	10	1.56
?	胸腔积液需要置管	21	3.29
?	气胸需要置管处理	11	1.72
循环系统		?	?
?	心律失常	31	4.85
?	心肌梗死	1	0.16
?	心功能不全	6	0.94
?	脑血管意外	4	0.63
?	下肢静脉血栓形成	7	1.10
?	肺栓塞	1	0.16
与外科技术相关		?	?
?	术后大出血	4	0.63
?	术后乳糜胸	13	2.03
?	术后切口感染	8	1.25
?	喉返神经损伤	20	3.13
?	术后早期死亡	6	0.94

Please choose a citation manager

Content to export