Abstract: Objective:To explore the application value of single-port inflatable mediastinoscopy combined with laparoscopy in the radical resection of esophageal cancer.
Methods:The retrospective descriptive study was conducted. The clinicopathological data of 27 patients who underwent single-port inflatable mediastinoscopic and laparoscopic radical resection of esophageal cancer in the General Hospital of Ningxia Medical University between September 2016 and April 2018 were collected. The surgical operators were divided into neck operation group and abdomen operation group. A “Y” tube was used to inflate the abdomen and mediastinum simultaneously with CO₂, and the gas pressure was 12-16 mmHg (1 mmHg=0.133 kPa). Bilateral exchange free and join forces with the esophagus and xiphoid process operating small incision, the severed esophagus cardia; residual stomach was made into a 3-5 cm tubular stomach and was sutured at the top point; at the same time, esophagus was brought up from the neck, with a pouch suture between upper esophageal and stapling head; the tubular stomach through mediastinum-esophagus bed was pulled to the left neck and then gastroesophageal anastomosis manually or instrument was performed. Observation indicators: (1) surgical and postoperative recovery; (2) follow-up and survival situations. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to May 2018. The measurement data with normal distribution were represented as ±s. The measurement data with skewed distribution were described as M (range).
Results:(1) Surgical and postoperative recovery: all the 27 patients underwent successful single-port inflatable mediastinoscopic and laparoscopic radical resection of esophageal cancer, with complete tumor resection and without conversion to open surgery. There was no arrhythmia or myocardial ischemia through intraoperative electrocardiography. Among 27 patients, 5 had intraoperative rupture of the pleura and 3 stopped intermittently inflation with CO₂ due to obvious hemodynamic changes. The operation time and volume of intraoperative blood loss were (121±21)minutes and (100±30)mL. Twenty-seven patients had no thoracic incision, obviously decreased postoperative pain and out-of-bed activity at day 1 postoperatively. The volume of postoperative mediastinal drainage was (40±10)mL. The mediastinal drainage-tube was removed at 1 week after regular food intake. Of 27 patients, 5 with pleural effusion were cured by puncture drainage; 2 were complicated with anastomotic leakage, 1 of them with a small amount of subcutaneous gas under neck incision at 12 days postoperatively was cured spontaneously through oral food intake, without special treatment, and the other had a small amount of subcutaneous gas under neck incision after solid food intake at 1 month postoperatively and then was cured after 1-week fluid food intake; 1 with anastomotic stenosis was improved after dilation treatment. The squamous cell carcinoma was confirmed by postoperative pathological examination, without cancer cell infiltration in the upper and lower margins. The numbers of mediastinal lymph node dissected, abdominal lymph nodes dissected and positive lymph node, postoperative pathological staging and duration of hospital stay were respectively 9.5±2.2, 8.2±2.5, 1 (range, 0-12), T1-3N0-1M0 and 13 days (range, 11-21 days). (2) Follow-up and survival situations: 27 patients were followed up for 1-20 months, with a median time of 10 months. During the follow-up, there was no recurrence or metastasis and death.
Conclusion:The single-port inflatable mediastinoscopy combined with laparoscopy in the radical resection of esophageal cancer is safe and effective, and it is especially suitable for patients with partial respiratory failure and closed thoracic cavity.