Thoracosopic-assisted Esophagectomy For Esophageal Cancer: Three Patterns Comparison

Objective: To discuss the three patterns of thoracoscopic-assisted esophagectomy.Methods : Three cases of esophageal cancer patients in The First Affiliated Hospital of Xiamen University. The first case separated and resected esophageal using thoracoscope , with mini-laparotomy laparotomy, cervical esophagogastric anastomosis; The second case separated the esophageal through video-assisted thoracoscopic, with standard laparotomy, intrathoracic esophagogastric anastomosis; The third case was laparoscopy combine thoracoscopic esophagectomy, with intrathoracic esophagogastric anastomosis. The recovery of patients, related complications and quality of life were observed and fellowed-up.Rezults: Three cases of patients during hospitalization and after discharge from hospital after six months of the recent follow-up.Whole group operation were success, no operative mortality. Thoracic surgery time was 60～120 minutes, an average of 93.3±30.5 minutes. Blood loss was 250～400 ml, an average of 306.7±81.4ml. After 3 days the average chest drainage was 150～300ml, an average of 250.0±86.6ml. VAS pain score after the first day was 2 to 3 points, with an average of 2.3 points. There was pulmonary infection occurred in one case, and that recovered after treatment. After six months follow-up, all patients survive without recurrence and metastasis, KPS score was 90 points. Conclusions: 1. thoracoscopic -assisted esophagectomy is safe and feasible way to overcome a variety of complications caused by traditional surgery. The smaller blood loss, less postoperative chest drainage, light postoperative pain, and reduction of surgical trauma, would improve quality of life of patients after the purpose. 2.Consistent than the intrathoracic anastomosis, cervical anastomosis is consistent with a wider range of clinical indications and better security. Although endoscopic intrathoracic anastomosis can reduce a neck incision, but more complicated steps, it could be performed consideredly if the operaters'technnique is perfect. 3. Traumas were not reduced significantly in Laparoscopic operations. Using laparoscopic-assisted operation in abdomen, pneumoperitoneum may affect the respiratory and circulatory functions for so much time was spent on settling procedure, and operaters have to do a mini incision for assistance. 4. Thoracoscopic operation with a mini incision could play a greater accessibility at this stage. With the technology developing, all endoscopic surgery may be gradually applied.