Analyses Of The Characteristics And Development Of Various Surgical Methods For Esophageal Cancers

Background:Esophageal cancer is one of the most common malignant tumors of digestive tract.This study retrospectively analyzed the cases first diagnosed as esophageal cancer in thoracic surgery of ChinaJapan Union Hospital of Jilin University from 2007 to 2017,and analyzed the changing trend and characteristics of the surgical methods of esophageal cancer in recent ten years,so as to provide a reference for the surgical treatment of esophageal cancer.Method:A total of 981 hospitalized patients with esophageal cancer diagnosed by thoracic surgery of China-Japan Union Hospital of Jilin University from 2007 to 2017 and treated by Ivor-Lewis,SWEET and McKeown were collected.The operation time,intraoperative bleeding volume,number of lymph node dissection and postoperative complications were collected.The changes of these operations from 2007 to 2017 were compared and analyzed.Result:Statistical analysis showed that the resection rate was 100%,39 perioperative deaths,24 Sweet,9 McKeown,6 Ivor Lweis,and respiratory failure caused by pulmonary infection.By comparing the surgical methods accepted by patients in the past 10 years,the right thoracic approach increased significantly in general,Ivor-Lewis approach increased from 14.6% in 2007 to 32.1% in 2017,McKeown approach increased from 12.5% in 2007 to 29.9% in 2017.The average operation time of the three surgical methods was significantly shortened.The average operation time of Sweet approach decreased gradually from 176.75±20.52 min in 2007 to 137.26±13.72 min in 2017.The average operation time of Ivor-Lewis operation decreased gradually from 210.56±25.94 min in 2007 to 173.61±19.98 min in 2017.The average operation time of McKeown operation decreased gradually from 344.15±28.92 min in 2007 to 262.43±25.58 min in 2017.In Sweet group,the average amount of intraoperative bleeding was 460.19±37.52 ml in 2007,305.42±22.47 ml in 2017,319.65±27.71 ml in Ivor-Lewis group in 2007,231.62±20.65 ml in 2017,495.95±62.97 ml in McKeown group in 2007 and 283.31±58.42 ml in 2017.This is mainly due to the advancement of operator technology and the increasing use of surgical instruments and hemostatic materials.The number of patients increased gradually,Sweet operation increased from 35 in 2007 to 51 in 2017,Ivor-Lewis operation increased from 7 in 2007 to 43 in 2017,and McKeown operation increased from 6 in 2007 to 40 in 2017,which was mainly related to the improvement of living standards and health awareness.Perioperative comparison: Sweet group had the shortest operation time,Ivor-Lewis group had the longest operation time,McKeown group had the largest average blood loss,Ivor-Lewis group had the least operation time,and McKeown group had the shortest operation time than the other two groups.Comparison of clinical efficacy: The total number of lymph node dissection was the highest in McKeown group and the lowest in Sweet group.The number of abdominal lymph node dissection was Ivor-Lewis group,McKeown group and Sweet group from more to less.The number of thoracic lymph node dissection was McKeown group,Ivor-Lewis group and Sweet group from more to less.The number of cervical lymph nodes dissected in McKeown group was(1.5 +0.9).Comparisons of perioperative complications: The probability of pulmonary infection,atelectasis and anastomotic leakage in McKeown group was higher than that in the other two groups,while the probability of gastric emptying disorder in Ivor-Lewis group was higher than that in the other two groups.Conclusion:Esophageal cancer surgery has made tremendous progress in recent decade,mainly reflected in the increase of right thoracic approach,the improvement of surgical instruments and the development of minimally invasive endoscopic esophageal cancer technology,which has shortened the operation time,reduced intraoperative bleeding,reduced the length of hospital stay,reduced the incidence of complications and deaths during hospitalization,and increased the number of lymph node dissection.There are advantages and disadvantages of three common surgical methods for esophageal cancer.Sweet operation advantages are simple procedure and short operation time,but the surgical incision is large,lymph node dissection is not thorough enough,which has a great impact on cardiac function.Ivor-Lewis operation can fully expose the thoracic esophagus and dissect the lymph nodes,especially the lymph nodes beside the recurrent laryngeal nerve.It avoids the diaphragm incision,protects the respiratory function and is conducive to the recovery after operation.The probability of gastric emptying disorder after Ivor-Lewis operation is higher than that of other operations.McKeown's operation is also more thorough for lymph node dissection.Because of the need for cervical incision anastomosis,the probability of anastomotic leakage after operation is higher than the other two methods.This operation has large wounds,more blood loss and a greater risk of postoperative pulmonary infection.