Esophagectomy With Thoracoscopy And Laparoscopy For Esophageal Carcinoma

Objective:To explore the feasibility of combined use of laparoscopic and thoracoscopic esophagectomy for the treatment of esophageal carcinoma.Methods : From November 2008 to March 2010, 67 cases of esophageal carcinoma were performed by this way. 67 patients were 47 males and 20 females, aged from 42 to 79 years old( average 62.63±9.01). There were 8 cases of carcinoma of the upper esophagus, 38 cases of carcinoma of the middle esophagus, 15 cases of carcinoma of the next segment, 6 cases of cardia cancer,The pathological types were 56 cases of squamous cell carcinoma and 11 cases of denocarcinoma. Video-assisted thoracoscopic surgical approach is to free the esophagus and lymph node dissection,laparoscopic surgical approach is to free stomach, through the retrosternal tunnel raised to the neck line of esophagogastric anastomosis of 40 cases,through the esophageal bed tunnel raised to the neck line of esophagogastric anastomosis of 17 cases. Laparoscopic surgical approach is to free stomach,thoracoscopic surgical approach is to free the esophagus and lymph node dissection,and anastomosed stomach to the esophagus with anastomat in the chest cavity of 10 cases.Results:All operative time was 240 ~ 500min with an average of 283.68±44.38min, thoracoscopic time 45~150min with an average of 94.91±27.20min, laparoscopic time 45~120min with an average of74.21±13.49min. There were 8~20 pieces of lymph nodes removed, with an average of 12.19±3.04 pieces. Intraoperative blood loss was 150ml ~ 350ml with an average of 222.81±59.81ml. Because of 9 cases of pleural adhesion and 1 case of clearly outside the tumor invasion, we had to converse to transit-assisted small incision in chest. There is no one for celiotomy. There was no one complicated by Intraoperative massive haemorrhage. There were 3~4 days for ICU with an average of 3.75±0.43 days, 10~56 days for hospitalization with an average of 15.82±7.64 days. The average of chest drainage of the first three days after operation were 195±110.94ml,162.89±107.95ml,152.46±111.53ml. The average of gastric juice of the first three days after operation were 37.89±29.02ml,104.65±70.63ml , 104.91±76.89ml. After postoperative 5~10 days (average of 7.96±1.59 days), intrathoracic drain were pull out. Postoperative complications included trachyphonia of 2 cases ,postoperative pulmonary complications of 3 cases,anastomotic fistula of 8 cases in the neck (after the first 6~14 days) which were healed after dressing,delayed gastric emptying of 1 cases (after the 34 days)which were cured by esophageal hiatus section. No postoperative chylothorax, arrhythmia was found. In TNM staging,there wereⅠof 2 case,ⅡA of 38 cases,ⅡB of 19 cases,Ⅲof 8 cases.Conclusion : Laparoscopic and thoracoscopic esophagectomy is feasible and safe for the treatment of esophageal carcinoma. There were less operative time , less operative blood loss , less pain and less complication. In the field of tumor resection, lymph node dissection , there is no significant difference with other surgical methods.