Combination of Thoracoscopy and Laparoscopy for Treatment of Esophageal Carcinoma
- VernacularTitle:胸、腹腔镜联合手术治疗食管癌
- Author:
Baofu CHEN
;
Chengchu ZHU
;
Dehua MA
- Publication Type:Journal Article
- Keywords:
Esophagectomy;
Thoracoscopy;
Laparoscopy
- From:
Chinese Journal of Minimally Invasive Surgery
2005;0(08):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the feasibility and safety of combination of thoracoscopy and laparoscopy for the treatment of esophageal carcinoma.Methods Combining thoracoscopic and laparoscopic esophagectomy was attempted in 23 patients with esophageal cancer between August 2007 and July 2008.Being placed at a left lateral decubitus position,the patients received right thoracoscopic mobilization of the intrathoracic esophagus as well as lymph node dissection;then with lithotomy position,laparoscopic mobilization of the stomach and lymph node dissection were carried out,followed by creation of a gastric tube through a small incision under the xiphoid;finally we pulled out the gastric tube from the esophageal bed to the neck and made an intermittent gastroesophageal anastomosis.Results One of the patients was converted to open abdominal surgery,whereas no one was converted to open thoracic operation.The total operation time ranged from 240 to 330 minutes with a mean of 270 minutes,the operation time for laparoscopy was 38-90 minutes(mean,65 minutes),and for thoracoscopy was 55-100 minutes(mean,70 minutes).No massive hemorrhage occurred during the operation,the total blood loss ranged from 100 to 300 ml(mean,225 ml),of which 10 to 50 ml were intra-abdominal blood loss(mean,20.4 ml).Totally 225 lymph nods were removed(9.8 per patient in average).Of the resected lymph nodes,65 were para-left gastric arterial or pericardial lymph nodes(2.8 per case).The mean hospital stay in this series was 9.2 days(range:8-12 days).During the hospitalization,no patient died;postoperative complications included pulmonary infection(3 cases),cervical anastomotic leak(one case,occurred in 8 days after the surgery),chylothorax(1 patient,cured by ligation via open thoracic surgery),and hoarseness(3 cases).Of the patient,23 received an follow-up for 1 to 11 months(mean,7.7 months),during which,1 patient died and 1 patient showed extensive metastasis to the mediastinal lymph node.Conclusion Combination of thoracoscopy and laparoscopy with cervical anastomosis is feasible and safe for the treatment of esophageal carcinoma.
