| Objective:Esophageal cancer is one of the most common malignanttumor of the digestive system, claiming approximately300000deathsworldwide annually. Its morbidity and mortality rates vary in differentcountries. China, one of the high-incidence areas for esophageal cancer, ishome to50%of the deaths caused by esophageal cancer with a crude mortalityrate of17.38/100000. Death toll of esophageal cancer in China accounts for16.4%of the total cancer-related counterpart, and the overall5-year survivalrate is less than10%. Esophagectomy is a preferred and prime therapy towardpatients with esophageal cancer owing to its high efficacy in tumor excisionand symptom alleviation. Since the report of the first case of esophagectomy,it has witnessed the transition of simple tumor excision to tumor excisioncombined with systematic lymphadenectomy as well as the shift of traditionalopen surgery to minimally invasive surgery aided by laparoscope. The firstreport of a successful intrathoracic esophago-gastrostomy by Wu et al in1940marked the commencement of rapid progress in surgery in China. Due toaggravated injury and postoperative complication caused by traditional opensurgery, minimally invasive surgery is the inevitable trend of development.With the advent of cold light source thoracoscope, high-definition camera,visual monitoring system and new endoscopic apparatus, laparoscope-aidedcholecystotomy was made possible. Moreover, thoracoscope-aided surgeriestargeting thoracic diseases also increased progressively, resulting in a numberof new surgical techniques. Minimally invasive surgery has been thedevelopmental frontier of thoracic surgery. Minimally invasiveesophagectomy, a newly-developed surgery in which laparoscope orthoracoscope (or both) are utilized in conducting esophagectomy to minimizesurgical trauma, is widely used in treating esophageal disease. However, the influence of minimally invasive esophagectomy on perioperative pulmonaryfunction and tissue injury are poorly understood. In this study, we investigatedthe pulmonary function and the blood levels of pro-inflammatory (IL-6, IL-8and TNF-α) and anti-inflammatory (IL-10) cytokines in69cases of patientsunderwent different esophagectomies preoperatively and postoperatively, andexplored the influence of different esophagectomies on pulmonary functionand tissue injury.Methods:Sixty-nine cases of patients with esophageal cancer wererecruited from The4thAffiliated Hospital of Hebei Medical University during2012and2013, and then divided randomly into two groups, i.e. the MIE(Minimally Invasive Esophagectomy) group and the open group. The MIEgroup consisted of34cases of patients with esophageal cancer that underwentminimally invasive esophagectomy aided either by laparoscope or bylaparoscope and thoracoscope. The open group comprised35cases of patientswith esophageal cancer that were subjected to traditional intrathoracicesophago-gastrostomy in a left posterolateral incision way. Vital Capacity(VC%), Forced Expiratory Volume (FEV%), Forced Vital Capacity (FVC%),Forced Expiratory Volume in1Second (FEV1%) and Maximum VentilatoryVolume (MVV%) were measured preoperatively and1month postoperatively.The floating degree of diaphragm was also measured preoperatively and12days postoperatively. In addition, concentrations of IL-6, IL-8, IL-10andTNF-α were consecutively measured preoperatively,1day postoperatively,3days postoperatively and5days postoperatively in fasting venous blood.Comparison and analysis of the aforementioned clinical indicators between thetwo groups were then carried out.Results：1Preoperatively, no significant difference is found between the twogroups in terms of VC%, FEV%, FVC%, FEV1%and MVV%(t values are1.403,-0.365,0.948,0.499and1.326respectively, all P>0.05), whereasVC%, FEV%, FVC%, FEV1%and MVV%of both groups are deceasedpostoperatively as compared to the preoperative counterparts. VC%, FEV%, FVC%, FEV1%and MVV%of the MIE group1month postoperatively aresuperior as compared to the counterparts of the open group (t values are2.830,1.804,2.643,1.823and1.735respectively，and the corresponding p values are0.006,0.076,0.010,0.073and0.087respectively), of which VC%and FVC%of the MIE group are significantly different from those of the open group.Preoperatively, no significant difference is found between the two groups interms of the floating degree of diaphragm (t value and P value are0.244and0.810respectively); however, twelve days post operation, the floating degreeof diaphragm of the MIE group is higher that that of the open group, althoughno significance is found (t value and P value are1.703and0.104respectively).2Preoperatively, no significant difference is found between the twogroups in terms of IL-6, IL-8, IL-10and TNF-α concentrations (t values are-1.03,-0.655,-1.58and-1.134respectively, all P>0.05), however IL-6, IL-8,IL-10and TNF-α concentrations of both groups are increased postoperativelyas compared to the preoperative counterparts. One day,3days and5dayspostoperatively, IL-6and TNF-α concentrations of the open group are allelevated as compared to the counterparts of the MIE group, with statisticalsignificances only found for TNF-α on the three time points (t values are-4.092,-2.826and-2.600respectively, all P<0.05). One day,3days and5days postoperatively, IL-8concentrations of the open group are all similar tothe counterparts of the MIE group (all P>0.05). however, one day,3days and5days postoperatively, IL-10concentrations of the open group are allincreased as compared to the counterparts of the MIE group (t values are-1.716,-2.031and-1.807respectively, and the corresponding P values are0.091,0.046and0.075respectively), with statistical significance only foundfor IL-10concentration on the time point of3days postoperatively.Conclusions:1Two modes of esophagectomies impair pulmonary function in varyingdegrees, Through between the two groups after the comparison of VC%, FVC%, manifests the cavity mirror auxiliary effect on lung function in patients with esophageal cancer resection is smaller than the traditional open thoracicesophageal cancer resection.2Two after operation of esophageal cancer resection patients peripheralblood TNFa all time points and IL-10in postoperative day3expression leveldifferences reflected in endoscopy surgery reduces postoperative inflammationadvantages, worth clinical promotion. |
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