The Curative Effect Of Minimally Invasive And Open McKeown Esophageal Resection In The Treatment Of Esophageal Cancer,and The Evaluation Of The Postoperative Quality Of Life

Objective:To evaluate the efficacy and postoperative quality of life of minimally invasive and open Mc Keown esophagectomy in the treatment of esophageal cancer.Methods:From September 2020 to November 2021,60 patients with esophageal cancer in our hospital were divided into minimally invasive group(MIE group)and open group(OE group).Patients in MIE group underwent thoracic laparoscopic esophagectomy combined with cervical esophagogastrostomy.OE group underwent esophagectomy with right upper thoracic abdominal incision and cervical esophagogastrostomy.The operative time(d),intraoperative blood loss(ml),number of lymph node dissection(number),postoperative thoracic drainage volume(ml),chest tube indwelling time(d),first time of getting out of bed(d),postoperative complications(pulmonary infection,anastomotic leakage,recurrent laryngeal nerve paralysis,chylothorax,incision infection),postoperative hospital stay(d)were analyzed.One month after operation,lung function[percentage of vital capacity to predicted value(VC%),percentage of forced vital capacity to predicted value(FVC%),percentage of forced expiratory volume to predicted value(FEV%),percentage of forced expiratory volume in first second to predicted value(FEV1%),percentage of maximal ventilation per minute to predicted value(MVV%)],immune function on the first and fifth day after operation[tumor necrosis factor-α(mg/ml),Interleukin-6(pg/ml),stress response index on the first and fifth day after operation[leukocyte count(×10~9L),C-reactive protein(mg/L),cortisol(nmol/L)].The quality of life of the patients in the two groups was evaluated by Quality of Life Questionnaire-Core 30(QLQ-C30),Oesophageal Specific Scale(QLQ-OES18)and Hospital Anxiety and Depression Scale(HADS).Results:(1)There was no significant difference in sex,age,tumor location and postoperative pathological stage between the two groups(P>0.05).(2)There were significant differences in operation time,intraoperative blood loss,chest drainage 24 hours after operation,chest tube indwelling time,first getting out of bed and hospitalization time between the two groups(P<0.05).There was no significant difference in the number of lymph node dissection(P>0.05).(3)There was significant difference in postoperative complications:pulmonary infection between the two groups(P<0.05),but there was no significant difference in anastomotic leakage,recurrent laryngeal nerve paralysis,chylothorax and incision infection(P>0.05).(4)One month after operation,there was significant difference in pulmonary function:VC%,FVC%,FEV%and FEV1%between the two groups,but there was no significant difference in MVV%.(5)Postoperative immune function:there was significant difference in TNF-αand IL-6 between the two groups on the first day and the fifth day after operation.(6)There was significant difference in WBC,CRP and cortisol between the two groups on the first day after operation,but there was no significant difference in WBC,CRP and cortisol on the fifth day after operation.(7)There was no significant difference in QOL-C30 score and symptom score between the two groups one week before operation,but there was significant difference in overall health status,body function,role function,social function,fatigue,pain and shortness of breath between one month and three months after operation(P>0.05).(8)There was no significant difference in QOL-OES18 score between the two groups one week before operation,but there was significant difference in pain score one month and three months after operation.(9)There was no significant difference in anxiety and depression scores between the two groups at one week before operation and one month after operation(P>0.05),but there was significant difference at three months after operation(P<0.05).Conclusion:Compared with open Mckeown esophagectomy,minimally invasive surgery has less damage to body and lung function,lower incidence of pulmonary infection and faster recovery.Minimally invasive surgery is also obviously superior to open surgery in terms of short-term quality of life after operation.