A Retrospective Study On Radicalness And Safety Of Minimally Invasive Esophagectomy

Objective This article aimed to analyze the radicalness and safety between minimally invasive Mckeown esophagectomy(MIE) and open Mckeown esophagectomy(OE) and to provide evidence for clinic.Methods 785 patients underwent Mckeown esophagectomy in Sichuan Cancer Hospital between January 2009 to July 2015, which performed by the same surgeon. 534 cases received MIE while 281 cases received OE. We compared the radicalness(including R0 resection and the number of lymph node dissection), safety, 1-year, 3-year and 5-year overall survival between two groups.Results The T stage, N stage, TNM stage and location of tumor between the two groups were significantly different(P<0.05). Safety:The blood loss, the first day drainage, three days drainage, postoperative ICU stay, postoperative hospital stay, blood transfusion, ligation of thoracic duct, readmission in ICU,complications, pneumonia, laryngeal recurrent nerve paralysis, chylothorax,wound infection of MIE were lower than OE(p < 0.05). The thoracic operating time in MIE is longer than the OE(P<0.05). The cervical and abdominal operating time, reoperation, perioperative mortality, arrhythmia, anastomotic fistula and anastomotic stricture between the two groups were no significantly different(P > 0.05). Radicalness: R0 resection is higher than the open group(P=0.006); The number of upper mediastinal lymph node dissection in MIE is lower than the OE(P =0.001); The number of middle mediastinal and abdominal lymph node dissection were similar to the OE, which was no significantly different(P > 0.05).The 1-year, 3-year, 5-year overall survival is better than the open group(81.9%, 56.8%, 44.0% vs 75.2%, 45.2%, 35.0%, P= 0.007). COX analysis showed that pathological type, T stage, N stage, the number of mediastinal lymph node dissection and age influenced on survival rates. In propensity-matching studying, 206 pairs of patients were selected and compared accordingly. The safety was consistent with before the match. R0 resection, the number of mediastinal lymph node dissection, 1-year, 3-year and5-year overall survival were detected between the two groups(P>0.05).Conclusion The minimally invasive Mckeown esophagectomy note only can achieve radical tumor resection but also be safe. The long-term survival in MIE are similar to OE.