Application of esophageal wire traction in lymph node dissection during three-hole thoracoscopic McKeown esophagectomy.

INTRODUCTION: The quality of left recurrent laryngeal nerve lymph node dissection is critical in esophageal cancer. We investigated whether esophageal wire traction in three-hole thoracoscopic esophagectomy can improve the same. MATERIAL AND METHODS: We retrospectively analyzed the data of 98 patients who underwent thoracoscopic esophagectomy in our center from January 2018 to July 2018: 36 patients with esophageal wire traction and 62 patients without traction (control group). The clearance time for left recurrent laryngeal nerve lymph nodes, thoracic bleeding volume, number of left recurrent laryngeal nerve lymph nodes, and complications were recorded. RESULTS: The observation group had a shorter clearance time for the left recurrent laryngeal nerve lymph nodes (15.8 ± 6.9 min vs. 20.00 ± 6.2 min), less thoracic bleeding (55.8 ± 30.2 mL vs. 70.7 ± 30.3 mL), and higher number of dissected left recurrent laryngeal lymph nodes (3.3 ± 1.4 vs. 2.5 ± 1.1) than the control group. There was no significant difference in the incidence of anastomotic leakage, pulmonary infection, arrhythmia, chylothorax, and nerve injury. CONCLUSIONS: Esophageal wire traction shortens the clearance time for the left recurrent laryngeal nerve lymph nodes, reduces thoracic bleeding, and improves the quality of left recurrent laryngeal nerve lymph node dissection in three-hole thoracoscopic esophagectomy.

Uniportal Thoracoscopic McKeown Esophagectomy.

We performed the technique of uniportal thoracoscopic McKeown esophagectomy. The incision was located in the fourth intercostal space on the right axillary midline. The right recurrent laryngeal nerve lymph nodes were dissected. Four hemlocks were applied to clamp the proximal and distal ends of the aortic arch. The esophagus was suspended with purse-string at the level of the azygos vein arch to assist the dissection of the left recurrent laryngeal nerve lymph nodes. A silk thread was drawn out from the incision in order to remove the subcarinal lymph nodes. A thoracic drainage tube was placed at the back of the incision at the end.

[Use of gastric tube in construction technique thoracoscopic and laparoscopic Ivor-Lewis esophagectomy].

OBJECTIVE: To discuss the safety and feasibility of gastric tube in construction technique in total thoracoscopic and laparoscopic Ivor-Lewis esophagectomy. METHODS: Clinical data of 358 patients with esophageal cancer who underwent the Ivor-Lewis procedure by the same surgical team in our department from June 2015 to June 2016 were retrospectively analyzed. Patients were divided into two groups: group MI (mini-incision): 92 patients undergoing extracorporeally gastric tube through a 4-cm abdominal mini-incision after gastric mobilization; group TL (total laparoscopy): 266 patients undergoing gastric tube made by total laparoscopy and jejunostomy. Intra-operative and postoperative data were compared between two groups. RESULTS: Of 358 patients, 290 were male and 68 were female. The average age was (62.3±15.6) years. The tumor location ratio of group TL and group MI was 27.1%(72/266) and 25.0%(23/92) in middle thoracic esophageal cancer, 35.3%(94/266) and 34.8%(32/92) in mid-lower thoracic esophageal cancer, and 37.6%(100/266) and 40.2%(37/92) in lower thoracic esophageal cancer, respectively. In group TL and group MI, 42.1% (112/266) and 46.7%(43/92) patients were stage I( to II(a; 57.9%(154/266) and 53.3%(49/92) patients were stage II(b to III(a, respectively. All the patients from two groups received successful Ivor-Lewis esophagectomy. There were no significant differences between group TL and MI in operative time [abdominal operative time: (65.6±25.8) min vs. (62.3±25.6) min; thoracic operative time: (180.3±37.4) min vs. (178.1±39.2) min; time of making gastric tube:(16.1±3.2) min vs.(15.7±3.5) min], blood loss [abdominal: (60.5±19.8) ml vs. (62.3±20.9) ml; thoracic: (228.7±47.3) ml vs. (231.6±46.8) ml], and the number of lymph nodes dissection (abdominal: 8.9±1.8 vs. 8.7±1.6; mediastinal: 21.2±3.6 vs. 20.8±3.8)(all P>0.05). And there were no significant differences in occurrence of postoperative anastomotic leakage [4.5%(12/266) vs. 4.3%(4/92), χ2=0.845, P=0.948], postoperative hospital stay [(12.2±4.8) d vs. (13.1±5.1) d, t=1.525, P=0.128] and average hospitalization cost(5.5±2.1 vs. 5.3±1.2, t=0.865, P=0.172) (ten thousand yuan, RMB) between group TL and MI. CONCLUSION: During minimally invasive Ivor-Lewis esophagectomy, gastric tube by total laparoscopy is safe and reliable.