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Abstract: Objective: McKeown esophagectomy followed by cervical and abdominal procedures has been commonly used for invasive esophageal carcinoma. This minimally-invasive operative procedure in the lateral prone position has been considered to be the most appropriate method. We describe our experiences in minimally invasive McKeown esophagectomy (MIME) for esophageal cancer. Methods: Between March 2016 and February 2018, a total of 82 patients underwent MIME by a single group in our department (a single center). All procedure, operation, oncology, and complication data were reviewed. Results: All MIME procedures were completed successfully, with no conversions to open surgery. The median operative time was 260 min, and median blood loss was 100 ml. The average number of total harvested lymph nodes was 20.1 in the chest and 13.5 in the abdomen. There were no deaths within 30 postoperative days. Twenty cases (24.4%) developed postoperative complications, including anastomotic leak in 4 (4.9%), single lateral recurrent nerve palsy in 4 (4.9%), bilateral recurrent nerve palsy in 1 (1.2%), pulmonary problems in 3 (3.7%), chyle leak in 1 (1.2%), and other complications in 7 (including pleural effusions in 4, incomplete ileus in 2, and neck incision infection in 1; 8.54%). Average postoperative hospitalization time was 12 d. Blood loss, operation time, morbidity rate, and the number of harvested lymph nodes were analyzed by evaluating learning curves in different periods. Significant differences were found in operative time (P=0.006), postoperative hospitalization days (P=0.015), total harvested lymph nodes (P=0.003), harvested thoracic lymph nodes (P=0.006), and harvested abdominal lymph nodes (P=0.022) among different periods. Conclusions: Surgical outcomes following MIME for esophageal cancer are safe and acceptable. The MIME procedure for stages I and II could be performed proficiently and reached an experience plateau after approximately 25 cases.

单中心单医疗组全腔镜食管癌切除的临床分析

[1]Amin MB, Greene FL, Edge SB, et al., 2017. The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin, 67(2):93-99.

[2]Bonavina L, Laface L, Abate E, et al., 2012. Comparison of ventilation and cardiovascular parameters between prone thoracoscopic and Ivor Lewis esophagectomy. Updates Surg, 64(2):81-85.

[3]Chen WQ, Zheng RS, Zhang SW, et al., 2013. Report of incidence and mortality in China cancer registries, 2009. Chin J Cancer Res, 25(1):10-21.

[4]Cheng YJ, Chan KC, Chien CT, et al., 2006. Oxidative stress during 1-lung ventilation. J Thorac Cardiovasc Surg, 132(3):513-518.

[5]Fabian T, McKelvey AA, Kent MS, et al., 2007. Prone thoracoscopic esophageal mobilization for minimally invasive esophagectomy. Surg Endosc, 21(9):1667-1670.

[6]Guo W, Ma X, Yang S, et al., 2016. Combined thoracoscopic-laparoscopic esophagectomy versus open esophagectomy: a meta-analysis of outcomes. Surg Endosc, 30(9):3873-3881.

[7]Kanemura T, Makino T, Miyazaki Y, et al., 2017. Distribution patterns of metastases in recurrent laryngeal nerve lymph nodes in patients with squamous cell esophageal cancer. Dis Esophagus, 30(1):1-7.

[8]Li XM, Li F, Liu ZK, et al., 2015. Investigation of one-lung ventilation postoperative cognitive dysfunction and regional cerebral oxygen saturation relations. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 16(12):1042-1048.

[9]Low DE, Alderson D, Cecconello I, et al., 2015. International consensus on standardization of data collection for complications associated with esophagectomy: esophagectomy Complications Consensus Group. Ann Surg, 262(2):286-294.

[10]Luketich JD, Alvelo-Rivera M, Buenaventura PO, et al., 2003. Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg, 238(4):486-494.

[11]Luketich JD, Pennathur A, Awais O, et al., 2012. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg, 256(1):95-103.

[12]Lv L, Hu WD, Ren YC, et al., 2016. Minimally invasive esophagectomy versus open esophagectomy for esophageal cancer: a meta-analysis. Onco Targets Ther, 9:6751-6762.

[13]Ma SH, Yan TS, Liu DD, et al., 2018. Minimally invasive esophagectomy in the lateral-prone position: experience of 124 cases in a single center. Thorac Cancer, 9(1):37-43.

[14]Meng FY, Li Y, Ma HB, et al., 2014. Comparison of outcomes of open and minimally invasive esophagectomy in 183 patients with cancer. J Thorac Dis, 6(9):1218-1224.

[15]Messager M, Pasquer A, Duhamel A, et al., 2015. Laparoscopic gastric mobilization reduces postoperative mortality after esophageal cancer surgery: a French nationwide study. Ann Surg, 262(5):817-823.

[16]Noshiro H, Miyake S, 2013. Thoracoscopic esophagectomy using prone positioning. Ann Thorac Cardiovasc Surg, 19(6):399-408.

[17]Okamura A, Watanabe M, Mine S, et al., 2016. Factors influencing difficulty of the thoracic procedure in minimally invasive esophagectomy. Surg Endosc, 30(10):4279-4285.

[18]Oshikiri T, Yasuda T, Hasegawa H, et al., 2017. Short-term outcomes and one surgeon’s learning curve for thoracoscopic esophagectomy performed with the patient in the prone position. Surg Today, 47(3):313-319.

[19]Tsujimoto H, Takahata R, Nomura S, et al., 2012. Video-assisted thoracoscopic surgery for esophageal cancer attenuates postoperative systemic responses and pulmonary complications. Surgery, 151(5):667-673.

[20]Xi Y, Ma ZK, Shen YX, et al., 2016. A novel method for lymphadenectomy along the left laryngeal recurrent nerve during thoracoscopic esophagectomy for esophageal carcinoma. J Thorac Dis, 8(1):24-30.

[21]Ye LY, Liu DR, Li C, et al., 2013. Systematic review of laparoscopy-assisted versus open gastrectomy for advanced gastric cancer. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 14(6):468-478.

[22]Yukaya T, Saeki H, Kasagi Y, et al., 2015. Indocyanine green fluorescence angiography for quantitative evaluation of gastric tube perfusion in patients undergoing esophagectomy. J Am Coll Surg, 221(2):e37-e42.

[23]Zhai CB, Liu YJ, Li W, et al., 2015. A comparison of short-term outcomes between Ivor-Lewis and McKeown minimally invasive esophagectomy. J Thorac Dis, 7(12):2352-2358.

[24]Zhou C, Zhang L, Wang H, et al., 2015. Superiority of minimally invasive oesophagectomy in reducing in-hospital mortality of patients with resectable oesophageal cancer: a meta-analysis. PLoS ONE, 10(7):e0132889.