Significance Of Total Mesoesophageal Esophagectomy In Minimally Invasive Radical Resection Of Esophageal Carcinoma

Objective:As a new comprehensive concept of surgical anatomy of esophagus with definition of meso-oesophagus.The effect of total mesoesesophageal esophagectomy in the treatment of esophageal cancer is still controversial.We aim to evaluate the perioperative efficacy of total mesoesophageal esophagectomy(TME)in Minimally invasive radical resection of esophageal carcinoma.Methods:A retrospective analysis on clinical data of 275 cases with esophageal squamous cell cancer confirmed by gastrosopic pathology and no distant metastasis by imaging date who underwent esophagectomy in Fujian Medical University Affiliated Union Hospital from December 2012 to December 2015.All the sugeries were underwent by the same treatment team with Minimally invasive radical resection of esophageal carcinoma and systematic lymph node dissection.The patients with preoperative neoadjuvant chemoradiotherapy were excluded.A total of 275 patients were included in postoperative pathology and perioperative efficacy indexes were compared between two groups including 125 cases of TME surgery group and 150 cases of traditional surgery group,if the tumor is located in the upper thoracic segment.Lymph node dissection should be performed with three-field lymph node dissection.Results:The basic information was not different between two groups.No perioperative death occurred in the two groups.Compared with traditional group,TME group had a shorter thoracic operative time [(106±18)min vs.(120±26)min,t=-5.042,P<0.001],and a shorter total operative time [(262±32)min vs.(290±44)min,t=-6.069,P<0.001] and less intraoperative blood loss [(90±26)ml vs.(143±69)ml,t=-8.634,P<0.001] and more retrieved lymph nodes in the thoracic part [(23.26±21.02)vs.(18.94±8.49),t=2.304,P=0.022] and mre total retrieved lymph nodes [(36.5±9.9)vs.(33.7±12.1),t=2.1,8 P=0.036].There were no significant difference between two groups in postoperative thoracic drainage volume [(1357±154)ml vs.(1407±384)ml,t=-1.457,P=0.147]?hospitalization days [(11.4±3.1)days vs.(12.1±2.9)days,t=-1.890,P=0.06]?chest tube indwelling days [(3.912±0.773)days vs.(4.087±0.843)days,t=-1.777,P=0.077] and hospitalization costs[(88652.9±20421.6)days vs.(84065±23847.4)days,t=1.694,P=0.091].Conclusions:Both TME group and traditional group were safe and effective.Compared with traditional group,TME group have more superiorities including in shortening thoracic operative time and total operative time,reducing intraoperative blood loss,and harvesting more retrieved lymph nodes in the thoracic part and total retrieved lymph nodes.Complications of two groups had not significant difference including pulmonary infection,chylothorax,gastric emptying,laryngeal nerve injury,arrhythmia,bleeding,incision into ICU cases.This type of operation is worthy of promotion.Long term prognosis is expected to be more sample size and follow-up time to confirm.