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Lobdell KW, Perrault LP, Drgastin RH, Brunelli A, Cerfolio RJ, Engelman DT. Drainology: Leveraging research in chest-drain management to enhance recovery after cardiothoracic surgery. JTCVS Tech 2024; 25:226-240. [PMID: 38899104 PMCID: PMC11184673 DOI: 10.1016/j.xjtc.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/18/2024] [Accepted: 04/01/2024] [Indexed: 06/21/2024] Open
Affiliation(s)
- Kevin W. Lobdell
- Sanger Heart & Vascular Institute, Wake Forest University School of Medicine, Advocate Health, Charlotte, NC
| | - Louis P. Perrault
- Montréal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | | | - Alessandro Brunelli
- Department of Thoracic Surgery, Leeds Teaching Hospitals, Leeds, United Kingdom
| | | | - Daniel T. Engelman
- Heart & Vascular Program, Baystate Health, University of Massachusetts Chan Medical, School-Baystate, Springfield, Mass
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Wang P, Fu YH, Qi HF, He P, Wang HF, Li C, Liu XC. Evaluation of the efficacy and safety of robot-assisted and video assisted thoracic surgery for early non-small cell lung cancer: A meta-analysis. Technol Health Care 2024; 32:511-523. [PMID: 37483035 PMCID: PMC10977398 DOI: 10.3233/thc-230201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/08/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Radical resection of lung cancer and chemotherapy are the main methods for the treatment of early lung cancer, but surgical treatment is still the key and preferred method. OBJECTIVE To evaluate the efficacy and safety of robotic-assisted thoracic surgery (RATS) and video assisted thoracic surgery (VATS) for non-small cell lung cancer (NSCLC). METHODS The clinical cohort studies on the comparison of the effects of RATS and VATS in the treatment of NSCLC published in Web of Science, PubMed, The National Library of Medicine (NLM), China National Knowledge Infrastructure (CNKI) and Wanfang database from January 1, 2015 to December 31, 2022 were searched. Two researchers independently screened the literature, extracted the data, such as operation time, intraoperative conversion rate, intraoperative blood loss, number of lymph nodes dissected, and evaluated the quality of the included literature based on the Newcastle-Ottawa Scale (NOS). RevMan 5.3 software was used for Meat analysis. RESULTS A total of 18 articles and 21,802 subjects were included. The results of the meta-analysis showed that the intraoperative blood loss of RATS was significantly less than that of VAS, and the difference was statistically significant [MD =-38.43 (95% CI: -57.71, -19.15, P< 0.001)]. Compared with VATS, the number of lymph nodes dissected in RATS was significantly higher [MD = 2.61 (95% CI: 0.47, 4.76, P= 0.02)]. The rate of conversion to thoracotomy in RATS was lower, and the difference was statistically significant [OR = 0.59 (95% CI: 0.50, 0.70, P< 0.001)]. There was no significant difference between RATS and VATS in operation time [MD =-9.34 (95% CI: -28.72, 10.04, P= 0.34)], postoperative thoracic drainage time [MD =-0.08 (95% CI: -0.42, 0.26, P= 0.64)], postoperative hospital stay [MD =-0.05 (95% CI: -0.19, 0.08, P= 0.42)], postoperative mortality [OR = 0.88 (95% CI: 0.56, 1.36, P= 0.56)] and postoperative complications [OR = 1.03 (95% CI: 0.93, 1.13, P= 0.57)]. CONCLUSION Compared with VATS, the number of lymph nodes dissected in RATS was significantly more, and the removal of lesions and lymph nodes was more thorough and accurate. More flexible and precise operation avoids the injury of important blood vessels during operation, effectively reduces the amount of blood loss during operation, shortens the indwelling time of thoracic drainage tube, and is conducive to postoperative rehabilitation of patients.
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Affiliation(s)
- Pu Wang
- Department of Cardiothoracic Surgery, The 82nd Group Military Hospital of PLA, Baoding, Hebei, China
| | - Yan-Hua Fu
- Department of Rheumatology and Immunology, Baoding Children’s Hospital, Baoding, Hebei, China
| | - Hong-Feng Qi
- Department of Cardiothoracic Surgery, The 82nd Group Military Hospital of PLA, Baoding, Hebei, China
| | - Peng He
- Department of Cardiothoracic Surgery, The 82nd Group Military Hospital of PLA, Baoding, Hebei, China
| | - Hai-Feng Wang
- Department of Cardiothoracic Surgery, The 82nd Group Military Hospital of PLA, Baoding, Hebei, China
| | - Chao Li
- Department of Cardiothoracic Surgery, The 82nd Group Military Hospital of PLA, Baoding, Hebei, China
| | - Xue-Cong Liu
- Department of Cardiothoracic Surgery, The 82nd Group Military Hospital of PLA, Baoding, Hebei, China
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Singh P, Gossage J, Markar S, Pucher PH, Wickham A, Weblin J, Chidambaram S, Bull A, Pickering O, Mythen M, Maynard N, Grocott M, Underwood T. Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS)/Perioperative Quality Initiative (POQI) consensus statement on intraoperative and postoperative interventions to reduce pulmonary complications after oesophagectomy. Br J Surg 2022; 109:1096-1106. [PMID: 36001582 PMCID: PMC10364741 DOI: 10.1093/bjs/znac193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/09/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND Pulmonary complications are the most common morbidity after oesophagectomy, contributing to mortality and prolonged postoperative recovery, and have a negative impact on health-related quality of life. A variety of single or bundled interventions in the perioperative setting have been developed to reduce the incidence of pulmonary complications. Significant variation in practice exists across the UK. The aim of this modified Delphi consensus was to deliver clear evidence-based consensus recommendations regarding intraoperative and postoperative care that may reduce pulmonary complications after oesophagectomy. METHODS With input from a multidisciplinary group of 23 experts in the perioperative management of patients undergoing surgery for oesophageal cancer, a modified Delphi method was employed. Following an initial systematic review of relevant literature, a range of anaesthetic, surgical, and postoperative care interventions were identified. These were then discussed during a two-part virtual conference. Recommendation statements were drafted, refined, and agreed by all attendees. The level of evidence supporting each statement was considered. RESULTS Consensus was reached on 12 statements on topics including operative approach, pyloric drainage strategies, intraoperative fluid and ventilation strategies, perioperative analgesia, postoperative feeding plans, and physiotherapy interventions. Seven additional questions concerning the perioperative management of patients undergoing oesophagectomy were highlighted to guide future research. CONCLUSION Clear consensus recommendations regarding intraoperative and postoperative interventions that may reduce pulmonary complications after oesophagectomy are presented.
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Affiliation(s)
- Pritam Singh
- Department of General Surgery, Royal Surrey NHS Foundation Trust, Surrey, UK
| | - James Gossage
- Department of Upper Gastrointestinal Surgery, Guy’s and St Thomas’ Hospitals NHS Trust, London, UK
| | - Sheraz Markar
- Department of Upper Gastrointestinal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Molecular Medicine and Surgery, Karolinska Institute, Solna, Sweden
| | - Philip H Pucher
- Department of Upper Gastrointestinal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Alex Wickham
- Department of Anaesthesia, Imperial College Healthcare NHS Trust, London, UK
| | - Jonathan Weblin
- Department of Physiotherapy, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | - Alexander Bull
- Department of Upper Gastrointestinal Surgery, Guy’s and St Thomas’ Hospitals NHS Trust, London, UK
| | - Oliver Pickering
- School of Cancer Sciences, University of Southampton Faculty of Medicine, Southampton, UK
| | - Monty Mythen
- Centre for Anaesthesia, Critical Care and Pain Management, University College London Hospitals NHS Foundation Trust, London, UK
| | - Nick Maynard
- Department of Upper Gastrointestinal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mike Grocott
- NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tim Underwood
- School of Cancer Sciences, University of Southampton Faculty of Medicine, Southampton, UK
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Bull A, Pucher PH, Lagergren J, Gossage JA. Chest drainage after oesophageal resection: A systematic review. Dis Esophagus 2022; 35:6377510. [PMID: 34585242 DOI: 10.1093/dote/doab069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/01/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Modern enhanced recovery protocols discourage drain use due to negative impacts on patient comfort, mobility, and recovery, and lack of proven clinical benefit. After oesophagectomy, however, drains are still routinely placed. This review aimed to assess the evidence for, and how best to use chest drains after oesophageal surgery. METHODS A systematic literature search was performed in Medline, Embase and Cochrane collaboration databases. Studies reporting outcomes for different types or uses of thoracic drainage, or outcomes related to drains after trans-thoracic oesophagectomy were included. Studies were collated into domains based on variations in number, position, type, removal criteria, diagnostic use and complications of drains. Methodological quality was assessed with Newcastle-Ottawa and Jadad scores. RESULTS Among 434 potentially relevant studies, 27 studies met the inclusion criteria and these included 2564 patients. Studies that examined the number of drains showed pain reduction with a single drain compared to multiple drains (3 studies, n = 103), and transhiatal placement compared to intercostal (6 studies, n = 425). Amylase levels may aid diagnosis of anastomotic leak (9 studies, n = 888). Narrow calibre Blake drains may effectively drain both air and fluid (2 studies, n = 163). Drain removal criteria by daily drainage volumes of up to 300 mL did not impact subsequent effusion rates (2 studies, n = 130). Complications related directly to drains were reported by 3 studies (n = 59). CONCLUSION Available evidence on the impact of thoracic drainage after oesophagectomy is limited, but has the potential to negatively affect outcomes. Further research is required to determine optimum drainage strategies.
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Affiliation(s)
- Alexander Bull
- Department of General Surgery, Guy's and St Thomas' NHS Trust, London SE1 7EH, UK
| | - Philip H Pucher
- Department of General Surgery, Guy's and St Thomas' NHS Trust, London SE1 7EH, UK.,Department of General Surgery, Portsmouth University Hospital NHS Trust, Portsmouth PO6 3LY, UK
| | - Jesper Lagergren
- Department of General Surgery, Guy's and St Thomas' NHS Trust, London SE1 7EH, UK.,School of Cancer and Pharmaceutical Sciences, Kings College London, London SE5 9NU, UK.,Department of Molecular medicine and Surgery, Karolinska Institutet, Stockholm 17177, Sweden
| | - James A Gossage
- Department of General Surgery, Guy's and St Thomas' NHS Trust, London SE1 7EH, UK.,School of Cancer and Pharmaceutical Sciences, Kings College London, London SE5 9NU, UK
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5
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Xu G, Du J, Zhang J, Chen H, Zheng B, Yang Z, Chen C. A propensity sore-matched study: Applying a modified chest tube drainage strategy in rapid rehabilitation following uni-portal thoracoscopic pulmonary wedge resection. Thorac Cancer 2022; 13:1657-1663. [PMID: 35481947 PMCID: PMC9161322 DOI: 10.1111/1759-7714.14438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 12/01/2022] Open
Abstract
PURPOSE This study aimed to compare the value of a modified chest tube drainage strategy to a traditional drainage strategy in single-port thoracoscopic pulmonary wedge resection. METHODS From January 2019 to July 2021, we collected clinical data on 405 patients who underwent single-port thoracoscopic pulmonary wedge resection in the No.1 Department of Thoracic Surgery at Fujian Medical University Union Hospital, with 121 (29.9%) cases in the modified drainage strategy group and 284 (70.1%) cases in the traditional drainage strategy group. The propensity score matching method (Match Ratio = 1:1) was used to reduce differences in clinical characteristics between the two groups. RESULTS Following 1:1 propensity score matching, 120 matched pairs (240 patients) were included in the study. There was no significant difference in general clinical characteristics between the two groups. There was no statistical difference in intraoperative factors except for operative times (71.42 ± 22.98 min vs. 86.80 ± 36.75 min, p < 0.001). In terms of postoperative factors, there were significant differences in postoperative chest tube duration (0.00 ± 0.00 h vs. 32.68 ± 18.51 h, p < 0.001), total drainage volume (143.03 ± 118.33 ml vs. 187.73 ± 140.82 ml, p = 0.008), postoperative hospital stay (2.61 ± 0.70 days vs. 3.27 ± 1.88 days, p < 0.001), number of additional pain relief (0.14 ± 0.40 vs. 0.42 ± 0.74, p < 0.001), facial pain score (2.7 ± 1.8 vs. 3.6 ± 2.7, p = 0.005) and adverse events (p = 0.046). Furthermore, there was a statistical difference between the two groups regarding CTCAE grade-1 complication, but no statistical difference in CTCAE grade-2 complication. CONCLUSIONS A modified drainage strategy in single-port thoracoscopic pulmonary wedge resection is safe and feasible, allowing for less postoperative rehabilitation time, pain relief, reduced postoperative pleural effusion, and reduced clinical workload.
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Affiliation(s)
- Guobing Xu
- Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouChina
| | - Jianting Du
- Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouChina
| | - Jiarong Zhang
- Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouChina
| | - Hao Chen
- Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouChina
| | - Bin Zheng
- Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouChina
| | - Zhang Yang
- Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouChina
| | - Chun Chen
- Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouChina
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Bruna M, Mingol F, Navasquillo M, Cholewa H, Vaqué FJ. "Tubeless" esophagectomy: Less is more. Cir Esp 2021; 99:457-462. [PMID: 34083165 DOI: 10.1016/j.cireng.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022]
Abstract
The esophageal cancer surgery is a complex procedure with elevated rates of both morbidity and mortality, which is why, in order to achieve adequate results, it should be performed in high volume centers, where complete multidisciplinary support is available and recent clinical guidelines are applied. We describe the initial experience and the technique of "tubeless" esophagectomy where esophageal resection and mediastinal lymphadenectomy are performed and no drains nor tubes of any kind are placed, with the aim to decrease the level of surgical aggression, enhance the postoperative comfort and accelerate the patient́s recovery.
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Affiliation(s)
- Marcos Bruna
- Unidad de Cirugía Esofagogástrica y Carcinomatosis Peritoneal, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - Fernando Mingol
- Unidad de Cirugía Esofagogástrica y Carcinomatosis Peritoneal, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Mireia Navasquillo
- Unidad de Cirugía Esofagogástrica y Carcinomatosis Peritoneal, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Hanna Cholewa
- Unidad de Cirugía Esofagogástrica y Carcinomatosis Peritoneal, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Francisco Javier Vaqué
- Unidad de Cirugía Esofagogástrica y Carcinomatosis Peritoneal, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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7
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Bruna M, Mingol F, Navasquillo M, Cholewa H, Vaqué FJ. "Tubeless" esophagectomy: Less is more. Cir Esp 2021. [PMID: 33468359 DOI: 10.1016/j.ciresp.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The esophageal cancer surgery is a complex procedure with elevated rates of both morbidity and mortality, which is why, in order to achieve adequate results, it should be performed in high volume centers, where complete multidisciplinary support is available and recent clinical guidelines are applied. We describe the initial experience and the technique of "tubeless" esophagectomy where esophageal resection and mediastinal lymphadenectomy are performed and no drains nor tubes of any kind are placed, with the aim to decrease the level of surgical aggression, enhance the postoperative comfort and accelerate the patient́s recovery.
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Affiliation(s)
- Marcos Bruna
- Unidad de Cirugía Esofagogástrica y Carcinomatosis Peritoneal, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - Fernando Mingol
- Unidad de Cirugía Esofagogástrica y Carcinomatosis Peritoneal, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Mireia Navasquillo
- Unidad de Cirugía Esofagogástrica y Carcinomatosis Peritoneal, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Hanna Cholewa
- Unidad de Cirugía Esofagogástrica y Carcinomatosis Peritoneal, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Francisco Javier Vaqué
- Unidad de Cirugía Esofagogástrica y Carcinomatosis Peritoneal, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, España
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8
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Wang D, Xu L, Yang F, Wang Z, Sun H, Chen X, Xie H, Li Y. The Improved Mediastinal Drainage Strategy for the Enhanced Recovery System After Esophagectomy. Ann Thorac Surg 2020; 112:473-480. [PMID: 33031778 DOI: 10.1016/j.athoracsur.2020.05.188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/11/2020] [Accepted: 05/27/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The improved drainage strategy was the transperitoneal placement of a single mediastinal drainage tube after esophagectomy. This study aimed to explore its effect on the incidence of postoperative complications, pain scores, and hospital stay. METHODS Data from 108 patients who underwent minimally invasive esophagectomy were retrospectively analyzed. Patients were divided into 2 groups: those in group A were treated with transthoracic placement of mediastinal drain and those in group B were treated with transperitoneal placement. The incidence of postoperative complications, pain scores, and postoperative hospital stay were compared. RESULTS The maximum pain scores in group B were significantly lower than those in group A from the first to the fourth postoperative days (PODs): POD1, 3.9 ± 0.7 vs 2.3 ± 0.7; POD2, 3.5 ± 0.8 vs 2.1 ± 0.7; POD3, 3.3 ± 0.8 vs 1.7 ± 0.8; and POD4, 3.1 ± 0.7 vs 1.7 ± 0.8 (all P < .001). Compared with group A, there were fewer postoperative analgesic drug users in group B (44.6% vs 17.9%; P = .005), fewer cases of pleural effusion (10.7% vs 0%; P = .045), and fewer cases of closed thoracic drainage due to pleural effusion or pneumothorax (14.3% vs 0%; P = .014). There were no significant differences in the incidence of anastomotic leakage, mediastinitis, major pulmonary complications, major abdominal complications, surgical site infection, and total postoperative complications, without statistical differences in postoperative hospital stay and 30-d mortality (all P > .05). CONCLUSIONS The transperitoneal placement of a single mediastinal drain can reduce postoperative pain and the incidence of pleural effusion, without increasing the incidence of other major postoperative complications and postoperative hospital stay.
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Affiliation(s)
- Dengyun Wang
- Department of Cardiothoracic Surgery, Huangshi Central Hospital, Affiliated Hospital of Hubei Ploytechnic University, Edong Healthcare Group, Huangshi, China
| | - Lei Xu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fan Yang
- Department of Cardiothoracic Surgery, Huangshi Central Hospital, Affiliated Hospital of Hubei Ploytechnic University, Edong Healthcare Group, Huangshi, China
| | - Zongfei Wang
- Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Haibo Sun
- Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Xiankai Chen
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hounai Xie
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yin Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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He J, Liu J, Zhu C, Dai T, Cai K, Zhang Z, Cheng C, Qiao K, Liu X, Wang G, Xu S, Yang R, Fan J, Li H, Jin J, Dong Q, Liang L, Ding J, He K, Liu Y, Ye J, Feng S, Jiang Y, Huang H, Zhang H, Liu Z, Feng X, Xia Z, Ma M, Duan Z, Huang T, Li Y, Shen Q, Tan W, Ma H, Sun Y, Chen C, Cui F, Wang W, Li J, Hao Z, Liu H, Liang W, Zou X, Liang H, Yang H, Li Y, Jiang S, Ng CSH, González-Rivas D, Pompeo E, Flores RM, Shargall Y, Ismail M, Ambrogi V, Elkhouly AG, Sung SW, Ang K. Expert consensus on tubeless video-assisted thoracoscopic surgery (Guangzhou). J Thorac Dis 2019; 11:4101-4108. [PMID: 31737292 DOI: 10.21037/jtd.2019.10.04] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jianxing He
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jun Liu
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Chengchu Zhu
- Department of Thoracic Surgery, Taizhou Hospital, Taizhou 318000, China
| | - Tianyang Dai
- Department of Thoracic Surgery, Southwest Medical University Affiliated Hospital, Luzhou 646000, China
| | - Kaican Cai
- Department of Thoracic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou 510120, China
| | - Zhifeng Zhang
- Department of Thoracic Surgery, Jieyang People's Hospital, Jieyang 522000, China
| | - Chao Cheng
- Department of Thoracic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Kun Qiao
- Department of Thoracic Surgery, Third People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Xiang Liu
- Department of Thoracic Surgery, Second Affiliated Hospital of the University of South China, Hengyang 420100, China
| | - Guangsuo Wang
- Department of Thoracic Surgery, People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Shun Xu
- Department of Thoracic Surgery, First Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Rusong Yang
- Department of Thoracic Surgery, Nanjing Chest Hospital, Nanjing 210000, China
| | - Junqiang Fan
- Department of Thoracic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200000, China
| | - Jiang Jin
- Department of Thoracic Surgery, Taizhou Hospital, Taizhou 318000, China
| | - Qinglong Dong
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Lixia Liang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jinfeng Ding
- Department of Anesthesia, Taizhou Hospital, Taizhou 318000, China
| | - Kaiming He
- Department of Thoracic Surgery, Southwest Medical University Affiliated Hospital, Luzhou 646000, China
| | - Yulin Liu
- Department of Anesthesia, Southwest Medical University Affiliated Hospital, Luzhou 646000, China
| | - Jing Ye
- Department of Anesthesia, Nanfang Hospital of Southern Medical University, Guangzhou 510120, China
| | - Siyang Feng
- Department of Thoracic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou 510120, China
| | - Yu Jiang
- Department of Anesthesia, Nanfang Hospital of Southern Medical University, Guangzhou 510120, China
| | - Haoda Huang
- Department of Thoracic Surgery, Jieyang People's Hospital, Jieyang 522000, China
| | - Huankai Zhang
- Department of Anesthesia, Jieyang People's Hospital, Jieyang 522000, China
| | - Zhenguo Liu
- Department of Thoracic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Xia Feng
- Department of Anesthesia, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Zhaohua Xia
- Department of Thoracic Surgery, Third People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Mingfei Ma
- Department of Anesthesia, Third People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Zhongxin Duan
- Department of Anesthesia, Second Affiliated Hospital of the University of South China, Guangzhou 510120, China
| | - Tonghai Huang
- Department of Thoracic Surgery, People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Yali Li
- Department of Anesthesia, People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Qiming Shen
- Department of Thoracic Surgery, First Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Wenfei Tan
- Department of Thoracic Surgery, First Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Hong Ma
- Department of Anesthesia, First Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Yang Sun
- Department of Anesthesia, Nanjing Chest Hospital, Nanjing 210000, China
| | - Congcong Chen
- Department of Anesthesia, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Fei Cui
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Wei Wang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jingpei Li
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Zhexue Hao
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Hui Liu
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Wenhua Liang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Xusen Zou
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Hengrui Liang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Hanyu Yang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Yingfen Li
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Shunjun Jiang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | | | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
| | - Raja M Flores
- Department of Thoracic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yaron Shargall
- Division of Thoracic Surgery, McMaster University, St. Joseph's Healthcare, Hamilton, Canada
| | - Mahmoud Ismail
- Department of Thoracic Surgery, Klinikum Ernst von Bergmann, Academic Hospital of the Charité - Universitätsmedizin Humboldt University Berlin, Potsdam Germany
| | - Vincenzo Ambrogi
- Department of Surgery and Experimental Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Ahmed G Elkhouly
- Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Sook Whan Sung
- Department of Thoracic & Cardiovascular Surgery, Ewha Womens University Seoul Hospital, Gangseo, Seoul, Republic of Korea
| | - Keng Ang
- Department of Thoracic Surgery, Nottingham City Hospital and Glenfield Hospital, Leicester, UK
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10
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Kato R, Makino T, Yamasaki M, Tanaka K, Miyazaki Y, Takahashi T, Kurokawa Y, Motoori M, Kimura Y, Nakajima K, Mori M, Doki Y. Risk factors associated with increased drainage volumes of chest tubes after transthoracic esophagectomy for esophageal cancer. Surg Today 2019; 49:1058-1065. [PMID: 31342160 DOI: 10.1007/s00595-019-01849-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/21/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Prolonged chest drain placement can extend the postoperative hospital stay after esophagectomy in esophageal cancer (EC) patients. This study aimed to identify whether or not the risk factors associated with this prolonged chest tube placement are clinically important. METHODS A total of 138 patients who underwent subtotal esophagectomy for thoracic EC were retrospectively analyzed. Using the 75th percentile of the total drainage volume of chest tubes as a cutoff value, the high-output (HO; n = 35) and low-output (LO; n = 103) groups were compared in terms of the clinicopathological parameters. RESULTS The median durations of right and left chest tube placement were 6 and 9 days, respectively, with a median total drainage volume of 2692 ml. When compared with the LO group, the HO group was significantly associated with male gender, a subcutaneous route for reconstruction, blood transfusion, higher morbidity, and prolonged chest drainage and postoperative hospital stays. A multivariable analysis further identified blood loss (p = 0.03) and the subcutaneous route for reconstruction (p = 0.04) as independent risk factors for increased chest tube drainage after esophagectomy. CONCLUSION Blood loss and the subcutaneous route of reconstruction are risk factors for increased drainage of chest tube after esophagectomy for EC.
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Affiliation(s)
- Ryo Kato
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Makoto Yamasaki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | | | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Masaaki Motoori
- Department of Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yutaka Kimura
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kiyokazu Nakajima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Masaki Mori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan
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11
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Tang RD, Yu Y, Chan KJ, Fenton-Lee D. Chest drain management post-oesophagectomy: a survey of Australian and New Zealand surgeons. ANZ J Surg 2019; 89:465-467. [PMID: 31034147 DOI: 10.1111/ans.15010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/06/2018] [Accepted: 11/09/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Richard D Tang
- School of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Yue Yu
- School of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Kevin J Chan
- Upper Gastrointestinal Surgery Unit, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Douglas Fenton-Lee
- Upper Gastrointestinal Surgery Unit, St Vincent's Hospital, Sydney, New South Wales, Australia.,School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia
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12
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Zheng Y, Li Y, Liu X, Zhang R, Wang Z, Sun H. Feasibility of a single mediastinal drain through the abdominal wall after esophagectomy. Medicine (Baltimore) 2018; 97:e13234. [PMID: 30431603 PMCID: PMC6257638 DOI: 10.1097/md.0000000000013234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study evaluated the safety and effectiveness of a single mediastinal drainage tube in the thoracic and abdominal cavity after minimally invasive esophagectomy (MIE). This study was undertaken to determine if the procedure could be included in a fast-track surgery program for resectable esophageal carcinoma (EC).From June 17 to November 30, 2015, clinical data for 78 eligible patients who had undergone a fast-track surgery program and MIE were retrospectively analyzed. Twenty-eight patients had a chest tube and mediastinal drainage tube. Thirty-four patients had only a mediastinal drainage tube through the intercostal space. The remaining 30 patients had a single mediastinal drainage tube in the thoracic and abdominal cavity through the abdominal wall. The complication rates and pain scores for each of the groups were compared. The statistical calculations were performed using SPSS 17.0 for Windows (SPSS Inc., Chicago, IL). The quantitative data among the groups were compared using 1-way analysis of variance (ANOVA). The Chi-square, Mann-Whitney U and Fisher exact tests were used for qualitative data analysis.There were no significant differences in the anastomotic leak rates, postoperative days and total complication rates (P = .861). The lowest visual analog scale (VAS) scores of the drainage tubes were observed in the group with a single mediastinal drain through the abdominal wall (P <.001).The results of this study suggested that a single mediastinal drainage tube in the thoracic and abdominal cavity after MIE may be safe and efficient. This clinical practice is a part of our fast-track surgery program.
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Affiliation(s)
- Yan Zheng
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan
| | - Yin Li
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianben Liu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan
| | - Ruixiang Zhang
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan
| | - Zongfei Wang
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan
| | - Haibo Sun
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan
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13
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Asti E, Sironi A, Bonitta G, Bernardi D, Bonavina L. Transhiatal Chest Drainage After Hybrid Ivor Lewis Esophagectomy: Proof of Concept Study. J Laparoendosc Adv Surg Tech A 2017; 28:429-433. [PMID: 29237133 DOI: 10.1089/lap.2017.0580] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Intercostal pleural drainage is standard practice after transthoracic esophagectomy but has some drawbacks. We hypothesized that a transhiatal pleural drain introduced through the subxyphoid port site incision at laparoscopy can be as effective as the intercostal drainage and may enhance patient recovery. PATIENTS AND METHODS A proof of concept study was designed to assess a new method of pleural drainage in patients undergoing hybrid Ivor Lewis esophagectomy (laparoscopy and right thoracotomy). The main study aims were safety and efficacy of transhiatal pleural drainage with a 15 Fr Blake tube connected to a portable vacuum system. Pre- and postoperative data, mean duration, and total and daily output of drainage were recorded in an electronic database. Postoperative complications were scored according to the Dindo-Clavien classification. RESULTS Between June 2015 and December 2016, 50 of 63 consecutive patients met the criteria for inclusion in the study. No conversions from the portable vacuum system to underwater seal and suction occurred. There was no mortality. The overall morbidity rate was 40%. Two patients (4%) required reoperation for hemothorax and chylothorax, respectively. Percutaneous catheter drainage for residual pneumothorax was necessary in 2 patients (4%) on postoperative day 2. The mean duration of drainage was 7 days (interquartile range [IQR] = 2), and the total volume of drain output was 1580 mL (IQR = 880). No pleural effusion on chest X-ray was detected at the 3-month follow-up visit. CONCLUSIONS Transhiatal pleural drainage is safe and effective after hybrid Ivor Lewis esophagectomy and could replace the intercostal drain in selected patients.
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Affiliation(s)
- Emanuele Asti
- Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan Medical School , Milano, Italy
| | - Andrea Sironi
- Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan Medical School , Milano, Italy
| | - Gianluca Bonitta
- Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan Medical School , Milano, Italy
| | - Daniele Bernardi
- Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan Medical School , Milano, Italy
| | - Luigi Bonavina
- Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan Medical School , Milano, Italy
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14
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Is thoracoscopic-laparoscopic esophagectomy a better alternative to thoracoscopic esophagectomy? Int J Surg 2017; 48:105-109. [PMID: 29061388 DOI: 10.1016/j.ijsu.2017.10.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Minimally invasive esophagectomy (MIE) is gaining rapid popularity as an alternative to conventional open esophagectomy. However, whether incorporating laparoscopy into MIE can further help the patients with esophageal cancer has rarely been studied. The aim of this study was to evaluate the short-term clinical efficacy of thoracoscopic-laparoscopic esophagectomy (TLE) compared with thoracoscopic esophagectomy (TE) in treating esophageal cancer. METHODS From September 2014 to December 2016, a total of 131 patients with esophageal cancer who had consecutively undergone MIE were included in the analysis; of them, TLE was performed in 71 patients and TE in 60 patients. Characteristics and perioperative outcomes of all patients were collected and compared to determine differences between the 2 groups. RESULTS Operation time (p = 0.172), chest drainage volume (p = 0.656), and pathologic staging (p = 0.671) were similar in the 2 groups. Compared with the TE approach, the TLE approach was associated with less blood loss during the operation (median, 100 vs 150 ml, p < 0.001), shorter chest drainage time (median, 2 vs 3 days, p < 0.001), a larger number of harvested lymph nodes (median, 24 vs 20, p < 0.001), and shorter postoperative hospital stay (median, 10 vs 11 days, p = 0.008). There was no significant difference between groups with regard to the major (grade ≥ III) and minor (grade < III) complications. CONCLUSIONS TLE is a safe and effective alternative to TE. Patients undergoing TLE may benefit from less blood loss, a larger number of harvested lymph nodes and faster postoperative recovery. Additional randomized controlled trial with longer follow-up is needed.
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