Top

World Journal of Surgery

Published in:

01-02-2014

Open Versus Thoracoscopic Esophagectomy in Patients with Esophageal Squamous Cell Carcinoma

Authors: Po-Kuei Hsu, Chien-Sheng Huang, Yu-Chung Wu, Teh-Ying Chou, Wen-Hu Hsu

Published in: World Journal of Surgery | Issue 2/2014

Abstract

Background

The impact of minimally invasive esophagectomy on patient prognosis, particularly disease-free survival (DFS), has not been well addressed. We compared the clinical outcomes of open and thoracoscopic esophagectomy in patients with esophageal squamous cell carcinoma (ESCC).

Methods

Sixty-three and 66 patients, nonrandomized, underwent open and thoracoscopic esophagectomies for ESCC between 2008 and 2011 were included. The clinicopathological data were reviewed retrospectively. Perioperative outcome, overall survival (OS), DFS, and the recurrence sites after open and thoracoscopic esophagectomy were compared.

Results

The open and thoracoscopic groups were comparable with regard to the total number of harvested lymph nodes and the percentage patients undergoing R0 resection. Fewer patients in the thoracoscopic group had pneumonia and wound complications. Intensive care unit (ICU) stay also was shorter in the thoracoscopic group. The recurrence pattern was similar in the two groups. In the open and thoracoscopic groups, the 3-year OS rates were 47.6 and 70.9 % (p = 0.031), respectively, and the 3-year DFS rates were 35 and 62.4 % (p = 0.007), respectively. However, the trends in better OS and DFS in the thoracoscopic group were not significant after stratification according to pathologic stage.

Conclusions

The perioperative benefit of thoracoscopic esophagectomy included fewer postoperative complications and shorter ICU stays. Mid-term OS and DFS associated with thoracoscopic techniques are at least equivalent to those associated with open procedures.

D’Annoville T, D’Journo XB, Trousse D et al (2012) Respiratory complications after oesophagectomy for cancer do not affect disease-free survival. Eur J Cardiothorac Surg 41:e66–e73PubMedCrossRef

Noble F, Curtis N, Harris S et al (2012) Risk assessment using a novel score to predict anastomotic leak and major complications after oesophageal resection. J Gastrointest Surg 16:1083–1095PubMedCrossRef

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

Osugi H, Takemura M, Higashino M et al (2003) A comparison of video-assisted thoracoscopic oesophagectomy and radical lymph node dissection for squamous cell cancer of oesophagus with open operation. Br J Surg 90:108–113PubMedCrossRef

Tagichi S, Osugi H, Higashino M et al (2003) Comparison of three-field esophagectomy for esophageal cancer incorporating open or thoracoscopic thoracotomy. Surg Endosc 17:1445–1450CrossRef

Safranek PM, Cubitt J, Booth MI et al (2010) Review of open and minimal access approaches to oesphagectomy for cancer. Br J Surg 97:1845–1853PubMedCrossRef

Smither BM, Gotly DC, Martin I et al (2007) Comparison of outcomes between open and minimally invasive esophagectomy. Ann Surg 245:232–240CrossRef

Braghetto I, Csendes A, Cardemil G et al (2006) Open transthoracic or transhiatal esophagectomy versus minimally invasive esophagectomy in terms of morbidity, mortality and survival. Surg Endosc 20:1681–1686PubMedCrossRef

Schoppmann SF, Prager G, Langer FB et al (2010) Open versus minimally invasive esophagectomy: a single-center case controlled study. Surg Endosc 24:3044PubMedCrossRef

10.

Shiraishi T, Kawahara K, Shirakusa T et al (2006) Risk analysis in resection of thoracic esophageal cancer in the era of endoscopic surgery. Ann Thorac Surg 81:1083–1089PubMedCrossRef

11.

Zingg U, McQuinn A, DiValentino D et al (2009) Minimally invasive versus open esophagectomy for patients with esophageal cancer. Ann Thorac Surg 87:911–919PubMedCrossRef

12.

Berger AC, Bloomenthal A, Weksler B et al (2011) Oncological efficacy is not compromised, and may be improved with minimally invasive esophagectomy. Am Coll Surg 212:560–568CrossRef

13.

Nagpal K, Ahmed K, Vats A et al (2010) Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis. Surg Endosc 24:1621–1629PubMedCrossRef

14.

Sgourakis G, Gockel I, Radtke A et al (2010) Minimally invasive versus open esophagectomy: meta-analysis of outcomes. Dig Dis Sci 55:3031–3040PubMedCrossRef

15.

Lazzarino AI, Nagpal K, Bottle A et al (2010) Open versus minimally invasive esophagectomy. Ann Surg 252:292–298PubMedCrossRef

16.

Hsu PK, Wang BY, Chou TY et al (2011) The total number of resected lymph node is not a prognostic factor for recurrence in esophageal squamous cell carcinoma patients undergone transthoracic esophagectomy. J Surg Oncol 103:416–420PubMedCrossRef

17.

Hsu PK, Wu YC, Chou TY et al (2010) Comparison of the 6th and 7th editions of the American Joint Committee on Cancer tumor-node-metastasis staging system in patients with resected esophageal carcinoma. Ann Thorac Surg 89:1024–1031PubMedCrossRef

18.

Hsu PK, Wang BY, Huang CS et al (2011) Prognostic factors for post-recurrence survival in esophageal squamous cell carcinoma patients with recurrence after resection. J Gastrointest Surg 15:558–565PubMedCrossRef

19.

Jamieson GG, Lamb PJ, Thompson SK (2009) The role of lymphadenectomy in esophageal cancer. Ann Surg 250:206–209PubMedCrossRef

20.

van Lanschot JJB, Hop WCJ, Voormolen MHJ et al (1994) Quality of palliation and possible benefit of extra-anastomotic reconstruction in recurrent dysphagia after resection of carcinoma of the esophagus. J Am Coll Surg 179:705–713PubMed

21.

Cuschieri A, Shimi S, Banting S (1992) Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb 37:7–11PubMed

22.

Marin DJ, Bessell JR, Chew A et al (2005) Thoracoscopic and laparoscopic esophagectomy. Surg Endosc 2005(19):1597–1601CrossRef

23.

Dantoc MM, Cox MR, Eslick GD (2012) Does minimally invasive esophagectomy provide for comparable oncologic outcomes to open techniques: a systematic review. J Gastrointest Surg 16:486–494PubMedCrossRef

24.

Thomson IG, Smithers BM, Gotley DC et al (2010) Thoracoscopic-assisted esophagectomy for esophageal cancer. Ann Surg 252:281–291PubMedCrossRef

25.

Kunisaki C, Kosaka T, Ono HA et al (2011) Significance of thoracoscopy-assisted surgery with a minithoracotomy and hand-assisted laparoscopic surgery for esophageal cancer: the experience of a single surgeon. J Gastrointest Surg 15:1939–1951PubMedCrossRef

26.

Petersen RP, Pham D, Burfeind WR et al (2007) Thoracoscopic lobectomy facilitates the delivery of chemotherapy after resection for lung cancer. Ann Thorac Surg 83:1245–1250PubMedCrossRef

27.

Groth SS, Al-Refaie WB, Zhong W et al (2013) Effect of insurance status on the surgical treatment of early-stage non-small cell lung cancer. Ann Thorac Surg 95:1221–1226PubMedCrossRef

28.

Rice TW, Rusch VW, Apperson-Hansen C et al (2009) World esophageal cancer collaboration. Dis Esophagus 22:1–8PubMedCrossRef

29.

Bhansali MS, Fujita H, Kakegawa T et al (1997) Pattern of recurrence after extended radical esophagectomy with three-field lymph node dissection for squamous cell carcinoma in the thoracic esophagus. World J Surg 21:275–281. doi:10.1007/s002689900228 PubMedCrossRef

30.

Abate E, DeMeester SR, Zehetner J et al (2010) Recurrence after esophagectomy for adenocarcinoma: defining optimal follow-up intervals and testing. J Am Coll Surg 210:428–435PubMedCrossRef

31.

Mariette C, Balon JM, Piessen G et al (2003) Pattern of recurrence following complete resection of esophageal carcinoma and factors predictive of recurrent disease. Cancer 97:1616–1623PubMedCrossRef

Title: Open Versus Thoracoscopic Esophagectomy in Patients with Esophageal Squamous Cell Carcinoma
Authors: Po-Kuei Hsu
Chien-Sheng Huang
Yu-Chung Wu
Teh-Ying Chou
Wen-Hu Hsu
Publication date: 01-02-2014
Publisher: Springer US
Published in: World Journal of Surgery / Issue 2/2014
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-013-2265-5

At a glance: The STEP trials

Springer Medicine

Open Versus Thoracoscopic Esophagectomy in Patients with Esophageal Squamous Cell Carcinoma

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2014

Flow Disruptions During Trauma Care

Clinical Utility of a Novel Hybrid Position Combining the Left Lateral Decubitus and Prone Positions During Thoracoscopic Esophagectomy

An Objective Evaluation of a Multi-Component, Competitive, Selection Process for Admitting Surgeons into Higher Surgical Training in a National Setting

Small Bowel Obstruction in Patients with a Prior History of Cancer: Predictive Findings of Malignant Origins

Erratum to: Prospective Randomized Controlled Trial on the Use of Flexible Reinforced Laryngeal Mask Airway (LMA) During Total Thyroidectomy: Effects on Postoperative Laryngopharyngeal Symptoms

Accidentally Ingested Toothpicks Causing Severe Gastrointestinal Injury: A Practical Guideline for Diagnosis and Therapy Based on 136 Case Reports