Thoraco-laparoscopic esophagectomy: thoracic stage in prone position

ABSTRACT Objective: to analyze the National Cancer Institute Abdominopelvic Division (INCA / MS/HC I) initial experience with thoraco-laparoscopic esophagectomy with thoracic stage in prone position. Methods: we studied 19 consecutive thoraco-laparoscopic esophagectomies from may 2012 to august 2014, including ten patients with squamous cells carcinoma (five of the middle third and five of the lower third) and nine cases of gastroesophageal junction adenocarcinoma (six Siewert I and three Siewert II). All procedures were initiated by the prone thoracic stage. Results: There were minimal blood loss, optimal mediastinal visualization, oncological radicality and no conversions. Surgical morbidity was 42 %, most being minor complications (58% Clavien I or II), with few related to the technique. The most common complication was cervical anastomotic leak (37%), with a low anastomotic stricture rate (two stenosis: 10.53%). We had one (5.3%) surgical related death, due to a gastric tube`s mediastinal leak, treated by open reoperation and neck diversion. The median Intensive Care Unit stay and hospital stay were two and 12 days, respectively. The mean thoracoscopic stage duration was 77 min. Thirteen patients received neoadjuvant treatment (five squamous cells carcinoma and eight gastroesophageal adenocarcinomas). The average lymph node sample had 16.4 lymph nodes per patient and 22.67 when separately analyzing patients without neoadjuvant treatment. Conclusion: the thoraco-laparoscopic approach was a safe technique in the surgical treatment of esophageal cancer, with a good lymph node sampling.

摘要
研究目的：分析国家癌症研究所腹盆腔分部（INCA / MS/HC I）采用俯卧位胸腔阶段胸腹腔镜食管癌切除术的初步临床经验。
研究方法：本研究纳入2012年5月至2014年8月期间的19例连续性胸腹腔镜食管癌切除术病例，其中10例为鳞状细胞癌患者（中段及下段病变各5例），9例为胃食管结合部腺癌患者（Siewert I型6例、Siewert II型3例）。所有手术均以俯卧位胸腔阶段作为起始步骤。
研究结果：术中失血量极少，纵隔视野清晰，达到肿瘤根治性切除标准，且无中转手术病例。术后并发症发生率为42%，其中绝大多数为轻度并发症（58%为Clavien I级或II级），与手术技术相关的并发症较少。最常见的并发症为颈部吻合口漏（37%），吻合口狭窄发生率较低（2例狭窄，占比10.53%）。1例（5.3%）患者因手术相关的胃管纵隔漏死亡，该患者接受了开放再次手术及颈部转流治疗。患者的重症监护病房中位停留时间及住院总时间分别为2天及12天。胸腔镜阶段手术平均时长为77分钟。13例患者接受了新辅助治疗（其中鳞状细胞癌5例，胃食管腺癌8例）。所有患者的平均淋巴结清扫数为16.4枚，未接受新辅助治疗的患者淋巴结清扫数平均为22.67枚。
研究结论：俯卧位胸腔阶段胸腹腔镜联合术式用于食管癌外科治疗安全性良好，且淋巴结清扫效果优异。