A propensity score matching study of the short-term efficacy of azygos arch-sparing McKeown minimally invasive esophagectomy

A revamped MIC-McKeown operation without removing azygos vein arch, bronchial artery and vagus nerve trunk

BACKGROUND

The purpose of this study was to investigate the effect of our revamped MIE-McKeown operation on postoperative gastrointestinal function recovery.

METHODS

This revamped MIE-McKeown operation without removing azygos vein arch, bronchial artery and vagus nerve trunk and with the tubular stomach buried throughout esophageal bed and azygos arch, has been implemented from July 2020 to July 2021 by the same medical team of Gaozhou People's Hospital thoracic surgery for 13 times. Preoperative clinical data, main intraoperative indicators and postoperative complications were observed.

RESULTS

All patients had esophageal malignant tumors at the level of middle and lower thoracic non-azygous venous arch, with preoperative clinical stage CT1-2N0M0 stage i-ii. V-vst test was performed on the 7th postoperative day, and 10 patients were found to have no loss of safety/efficacy. There were 2 cases with impaired efficacy and no impaired safety, 1 case with impaired safety. There were 1 cases of pulmonary infection, 1 cases of anastomotic fistula combined with pleural and gastric fistula, 2 cases of hoarseness, 2 cases of arrhythmia, 10 cases of swallowing function were grade i, 2 cases of swallowing function were grade iii, 1 case of swallowing function was grade iv in watian drinking water test one month after operation.

CONCLUSIONS

Merit of this revamped MIE-McKeown operation is well preserving the integrity of azygos arch of vagus nerve and bronchial artery, and it is technically safe and feasible. No postoperative mechanical obstruction of thoracostomach, huge thoracostomach and gastrointestinal dysfunction occurs.

Comparison of McKeown Minimally Invasive Esophagectomy vs sweet esophagectomy for esophageal squamous cell carcinoma: A retrospective study

There are two most widely used transthoracic esophagectomy methods: the McKeown Minimally Invasive esophagectomy (McKeown MIE) and the Sweet Esophagectomy. We evaluated and compared the therapeutic effects of these two methods to determine the appropriate method for the treatment of middle and lower third esophageal cancer patients who received neoadjuvant chemotherapy combined with immunotherapy (NACI). We retrospectively analyzed 43 sweet esophagectomy cases received NACI and 167 cases with McKeown MIE in the fourth hospital of Hebei Medical University from December 2019 to May 2022. This retrospective observational study showed that Sweet esophagectomy and McKeown MIE after NACI therapy for resectable ESCC patients appeared to be safe with low operative mortality and morbidity rate in the current population. In addition, sweet esophagectomy was associated with a lower incidence of severe complications and shorter hospital stay for patients over 70 years of age compared with McKeown MIE. There were no differences were found in length of stay, mortality and complication incidence rate between the two groups. The Sweet approach has advantage in hospital stay for the treatment of the elderly NACI patients with middle or lower third esophageal squamous cell carcinoma. In conclusion, Sweet esophagectomy and McKeown MIE are both safe, effective, and worthwhile approaches for ESCC patients in immunotherapy age.

Case Report and Minireview of the Literature on Blunt Azygos Injury

Azygos vein injury seems to be an uncommon cause of hemothorax and hemomediastinum; however, this injury is potentially fatal. We report a fatal case of blunt azygos injury and a PubMed search was undertaken to identify English articles from 1989 to 2022 using the key words "azygos", "injury" and "blunt". We found 28 articles about blunt azygos injury and 39 patients including the present case (average 41.2 years [range: 18-81 years]; male, n=20; female, n=19). The other variables were as follows: right hemothorax (n=32); unstable circulation on arrival (n=32); and survival (n=19; unknown, n=2). These cases were divided into two groups based on the outcome: the survival group and the fatal group. There were no significant differences with regard to the year of the report, age, sex, rate of right rib fracture, rate of preoperative computed tomography (CT) examination, rate of associated injury, and rate of operation. The rate of shock on arrival in the survival group was significantly lower than that in the fatal group. The rate of azygos arch injury in the survival group was significantly greater than that in the fatal group. The emergency physician must consider azygos vein injury as a possible cause of right hemothorax when a patient with blunt chest trauma presents persistent hypotension.