| Background:Esophageal cancer is a common digestive tract malignant tumor in our country,and surgery is the main method of treatment.Traditional open esophagectomy is big traumatic,The incidence of postoperative complications is high,postoperative life quality is poor,make a lot of poor physical condition of the patients had to give up surgery.With minimally invasive technique in thoracic surgery,Minimally invasive esophageal surgery arises at the historic moment,Among them,the minimally invasive Mckeown combined with thoracic laparoscopy has become the most representative minimally invasive esophageal cancer surgery.Although the safety of minimally invasive surgery for esophageal cancer has been proven for more than a decade,a large number of retrospective control studies have confirmed that minimally invasive surgery for esophageal cancer is one of the alternatives to traditional surgery,but its efficacy is still controversial.Some scholars believe that minimally invasive surgery is difficult and takes too long,the intraoperative operation has certain risks,and the requirements for surgeons are relatively high.It is difficult for inexperienced surgeons to successfully complete MIE surgery.In addition,whether the incidence of postoperative complications of minimally invasive surgery is lower than that of open surgery and whether minimally invasive surgery has advantages in intraoperative operation remains to be investigated.Successful completion of MIE surgery requires good preoperative preparation,improved surgical skills.However,previous studies have shown that about 0%-14% of patients converted to open-heart surgery during MIE surgery,half of which were forced to convert to open-heart surgery due to intraoperative emergency,and MIE increased the cost and risk of patients during the operation.Therefore,to understand the causes of intraoperative MIE transit and its effect on prognosis,and to strengthen the training of operators’ operation techniques are the key to reduce intraoperative MIE transit.Objective:The purpose of this study was to summarize the reasons and significance of mid-intraoperative thoracotomy in MIE,and to evaluate the effect on long-term survival.To investigate the reasons of intraoperative thoracotomy for minimally invasive esophageal cancerTo understand the technical difficulties of MIE surgery,Reduce the suffering and financial burden of patients.In addition,through the analysis of the survival rate of patients undergoing intraoperative thoracotomy in MIE,the influence of intraoperative transition on the prognosis of patients was clarified,providing evidence for the selection of more effective surgical methods for the treatment of esophageal cancer.Methods:There were 293 thoracoscopic esophagectomies for esophageal squamous cell carcinoma(ESCC)of the thoracic esophagus performed by the authors from September 2009 to August 2015.Totally,257 patients were enrolled in this study.These patients were divided into two groups(those underwent complete MIE and those converted to open thoracotomy)and then compared.A standardized preoperative evaluation,as well as a postoperative method of following at a regular frequency were adopted for all of these patients.The clinicopathologic characteristics and the perioperative variables were retrospectively analyzed.Univariate and multivariate analyses were performed to identify prognostic factors.The Kaplan–Meier method was used to compare survival differences,and draw a survival curve.Results:1.There were 231 patients(89.9%)underwent successful thoracoscopic esophagectomy(Group 1),and 26 cases(10.1%)required conversion to open procedure(Group 2).The majority of conversion(73.1%,19/26)occurred in the initial 100 cases.2.There was no significant difference in background and clinicopathological factors between the two groups,but patients in Group 2 had significantly longer operative time and more operative blood loss.3.Among the 26 patients of Group 2,there were nine cases that need emergent conversion for various reasons.And the most common cause for emergent conversion was intraoperative bleeding.4.The incidence of postoperative complications was significantly higher in patients undergoing esophageal cancer surgery than in patients who did not need to undergo esophageal cancer surgery.5.Univariate and multivariate analyses all demonstrated that intraoperative conversion did not significantly influence the overall or recurrence-free survival of these patients.Conclusions:Univariate analysis and multivariate Cox proportional hazard regression analysis indicated that intraoperative conversion did not significantly influence the OS and RFS rate of these patients.Our results demonstrated that the intraop-erative conversion did not affect the long-term survival of patients underwent MIE for ESCC. |
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