Long-term Efficacy And Prognostic Factors Of Thoracoscopic Laparoscopic Esophagectomy With Intrathoracic Anastomosis For Esophageal Cancer

Objective To explore the outcomes and prognostic factors of thoracoscopic laparoscopic esophagectomy with intrathoracic anastomosis for esophageal cancer.Methods The retrospective case-control study was conducted.The clinicopathological data of 201 patients who underwent TLE-chest for primary esophageal cancer in the First Affiliated Hospital of Anhui Medical University(FAHAMU)from November 2011 to December 2015 were collected.Observation indicators:(1)Preoperative conditions.(2)treatment.(3)postoperative pathological examination.(4)follow-up situation.Follow-up using outpatient examination and telephone.The follow-up contents were number of patients,follow-up time,patient's survival,tumor metastasis and recurrence and overall survival rate.The patients' death was regarded as the end of follow-up.Follow-up date ends at December 31 th,2018.The patients' overall survivals were analyzed using KaplanMeier curve.Results(1)Preoperative conditions.168(83.6%)patients were males and 33(16.4%)were females.The mean age of patients was 62.7 years old(range from 40 to 88).150(74.6%)patients' tumors were located in the middle of esophagus,whereas 51(25.4%)tumors were in the low.(2)treatment.The average of total operation time was 293.9 min.Among them,the means of VATS and LS time were 156.9 min and 116.5 min respectively.The mean of intraoperative blood loss was 77.5 ml,the chest tube duration time that was up to 8.9 days averagely,only 7(3.5%)patients suffered from anastomotic fistula,pulmonary complications were observed in 21(10.4%)patients.Among them,the rates of pulmonary infection,asthma and atelectasis were 9.4%(19/201),0.5%(1/201)and 0.5%(1/201)respectively.Only 5(2.5%)patients occurred RRLN injury in lymph nodes dissection.5(2.5%)suffered chylothorax after TLE-chest and hydrothorax was observed in 28(13.9%)patients.The rates of other complications containing anastomotic stenosis,bleeding and delayed gastric empty were 0.5%(1/201),1.5%(3/201)and 0.5%(1/201)respectively.(3)postoperative pathological examination.The mean of tumor size was 3.7 cm and the numbers of postoperative pathological TNM classification I,II,III and IV were 38(18.9%),72(35.8%),73(36.3%)and 18(9%)respectively.The number of resected lymph nodes was 22.9±9.7(maximum: 58).(4)follow-up situation the followup period for 201 patients is 5-87 months(mean 50.3 months).At the first month after TLE-chest,the score of quality of patients' life was 85±6.5.And at the 12 month,quality of life was improved by 4.1%.Until up to the 24 months,patients' quality of life was recovered to 90±7.5.There was a statistically significant difference in the 3-year cumulative survival between the upper mediastinal lymph node(UM-LN)metastasis group and the non-metastasis group(P = 0.027).Moreover,the 3-year cumulative survival rate of patients with abdominal lymph node(A-LN)negative was better than that of patients with A-LN metastasis(P < 0.001).Analysis of prognostic factors by univariate analysis showed that pathological T / N / TNM staging,upper mediastinal and abdominal lymph node negative were associated with 3-year cumulative survival,and multivariate analysis showed that overall operative time,tumor T stage,N stage,and TNM staging affected TLE-chest Independent risk factors for survival in patients with Chest surgery.Conclusion Thoracic laparoscopic combined with esophagostomy for thoracic anastomosis for long-term survival of esophageal cancer is satisfactory,TLE-chest standardized upper mediastinal lymph node(UM-LN)and abdominal lymph node(A-LN)dissection for long-term survival of patients was important.T,N,and TNM staging are independent risk factors for survival in patients with TLE-chest surgery.