To investigate the impact of unplanned events during minimally invasive esophagectomy(MIE) on early postoperative recovery.

The clinical data of 303 consecutive patients undergoing MIE by the same operation group in Department of Thoracic Surgery, Shanghai Chest Hospital affiliated to Shanghai Jiaotong University between January 2011 and December 2015 were retrospectively analyzed. Patients were divided into unplanned group(85 cases) and planned group(218 cases) based on the presence and absence of unplanned events during operation, and the incidences of postoperative complications were compared between two groups.

(1) The most common unplanned events during MIE were pleural or/and peritoneal adhesion(28/89, 31.5%). Intraoperative accidental discovery of deep tumor invasion (sT4a+ T4b) ranked second (25/89, 28.1%). (2) The incidences of respiratory system complications(57.6%), nervous system complications (10.6%), postoperative infection (32.9%)and chylothorax (8.2%) in unplanned group were significantly higher than those in planned group(8.3%, 2.8%, 5.0%, 0.9%, respectively) (χ²=12.138, 8.026, 10.336, 8.325, respectively; P<0.05). (3) The most common reasons for transference from MIE to thoracotomy or laparotomy were pleural/peritoneal adhesion (9/38, 23.7%) and bleeding(7/38, 18.4%). (4) The main reasons for R2 resection were tumor invasions of trachea/bronchus(7/21, 33.3%) and aorta(5/21, 23.8%).

The unplanned events during MIE increases the incidence of postoperative complications. With the increase in experience for MIE, unplanned events will decrease. Preoperative accurate clinical TNM staging can reduce the incidence of unplanned events during MIE.