Comparative Study Of Thoracic And Cervical Anastomosis In Minimally Invasive Esophagectomy

Objective:Comparative analysis of video-assisted thoracoscopy combined with laparoscopic minimally invasive esophageal carcinoma in the treatment of lower thoracic esophageal carcinoma with the advantages and disadvantages of right anterior incision and left anastomosis.Methods: The clinical data of 10 patients undergoing thoracoscopic thoracoscopic thoracic and lower esophageal cancer radical surgery were retrospectively analyzed,including 46 cases of thoracic esophageal carcinoma and 6 cases of thoracic esophageal carcinoma 34 cases,according to different surgical methods will be divided into 80 cases of right anesthesia group and left anastomosis group.There were 38 cases of right thoracic anastomosis,including 24 cases of thoracic esophageal carcinoma,14 cases of thoracic esophageal carcinoma,42 cases of left anastomosis,22 cases of thoracic esophageal carcinoma and 20 cases of thoracic esophageal carcinoma.The indexes included: time of operation,intraoperative blood loss,average number of lymph nodes,mean lymph node count,total lymph node metastasis rate,postoperative discharge time,postoperative feeding time,postoperative hospital stay,hospitalization cost,postoperative Complications such as esophageal anastomotic fistula or tube fistula,pulmonary infection,recurrent laryngeal nerve injury,chylothorax,incision infection,arrhythmia,chylothorax,gastric emptying disorders.Results: There was no significant difference in clinicopathological features between the two groups.There was no significant difference between the operation time and the postoperative hospital stay in the right thoracic anastomosis group(P> 0.05).(P <0.05).The intraoperative blood loss,average number of lymph nodes,average number of mediastinal lymph nodes,and the number of medial mediastinal lymph nodes in the right thoracic anastomosis group were significantly higher than those in the left anastomosis group There was no significant difference in total lymph node metastasis rate and operation cost between the two groups(P> 0.05).The incidence of pulmonary infection,recurrent laryngeal nerve injury and anastomotic fistula in the right thoracic anastomosis group was lower than that in the left anastomosis group(P <0.05).The postoperative arrhythmia,incision infection,chylothorax,There was no significant difference between the two groups(P> 0.05).A total of 78 patients(97.5%)were followed up for 1-26 months with an average of(12.5 ± 6.7)months.The median follow-up was 11 months.There was no statistically significant difference between the two groups of patients during the follow-up period,the postoperative radiotherapy and chemotherapy,local recurrence rate or distant metastasis rate,anastomotic stenosis,death and overall survival rate.Conclusion: In the lower thoracic esophageal cancer minimally invasive surgery,the right thoracic anastomosis and the left cervical anastomosis of the same security,can be completely cleaned area lymph nodes and postoperative accurate pathological staging,but postoperative anastomotic fistula,recurrent laryngeal nerve injury and lung The incidence of infection was lower,the complications were significantly less than the left neck.The quality of life of the two groups of patients(postoperative anastomotic stenosis,reflux,etc.),tumor recurrence and metastasis and the recent survival rate was no significant difference,with good near-term efficacy,safe and feasible.