Analysis, Prevention and Treatment of Complications of 165 Patients with Thoracoscopic Esophagectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIXiao-xiang ,  LVBi-hong , HEGuang-ming , JIANGWei , XUXiang , HEJing , CHENRui

Department of Cardiothoracic Surgery, Taixing People’s Hospital Affiliated to Yangzhou University, Taixing 225400 Jiangshu, P.R.China;

Corresponding?author：

LVBi-hong, Email: ZXXXX7576@163.com

Keywords：

Esophageal cancer; Thoracoscopic esophagectomy; Complications during and after operation; Prevention

DOI：

10.7507/1007-4848.20160081

Video：

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Objective To evaluate the characteristics and reasons of complications in the patients with thoracoscopic esophagectomy. Methods We retrospectively analyzed the clinical data of 165 patients with thoracoscopic esophagectomy in our hospital from January 2013 through January 2015. There were 102 males and 63 females at average age of 67.9±8.3 years. Results The operation time was 275.3±50.2 min. The intraoperative blood loss was 230.0±110.5 ml. The number of lymph node dissection was 18.1±6.5. The volume of drainage in thoracic cavity was 750±550 ml on the third day after operation. Thoracoscopic esophagectomy surgeries were successful except that 13 patients (7.8%) converted to open operation including 6 patients (4.2%) with severe pleural adhesion, 2 patients (1.2%) with hemorrhage, 2 patients (1.2%) with arrhythmia, and 3 patients (1.8%) with abnormal oxygenation. There were 17 patients (10.8%) were with intraoperative complications including 2 patients (1.2%) with arrhythmia, 3 patients (1.8%) with abnormal oxygenation, 7 patients (4.2%) with hemorrhage caused by vascular injury, 4 patients (2.4%) with thoracic duct injury, 1 patient (0.6%) with recurrent laryngeal nerve injury. Moreover, 46 patients (27.8%) experienced postoperative complications including 23 patients (13.9%) with pulmonary infection, 6 patients (3.6%) with hoarseness, 4 patients (2.4%) with anastomotic leakage, 3 patients (1.8%) with incision infection, 2 patients (1.2%) with tracheoesophageal fistula, and 2 patients (1.2%) with pneumothorax. Unexpectedly, five patients underwent re-operation due to chylothorax (n=3, 1.8%) and hemorrhage (n=2, 1.2%). One patient (0.06%) died of acute pulmonary embolism. Conclusion Serious adhesion in abdominal cavity, abnormal of lung and heart. And bleeding are the main reasons caused transferring open thoracic surgery operation in patients with thoracoscopic esophagectomy. Lung infection, hoarseness, and anastomotic leakage of neck are the most common postoperative complications. And acute pulmonary embolism is the main cause of postoperative death. Proper precautions to decrease the morbidity of complication are necessary.

Citation： XIXiao-xiang, LVBi-hong, HEGuang-ming, JIANGWei, XUXiang, HEJing, CHENRui. Analysis, Prevention and Treatment of Complications of 165 Patients with Thoracoscopic Esophagectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(4): 352-356. doi: 10.7507/1007-4848.20160081 Copy

1.	鄒小農, 陳萬青, 張思維, 等. 中國部分市縣1998-2002年食管發病與死亡. 中國腫瘤, 2007, 16(3): 142-146.
2.	陳龍奇. 食管癌國際TNM分期解讀與評價.中華腫瘤雜志, 2010, 32(3): 237-240.
3.	Pham TH, Perry KA, Dolan JP, et al. Comparison of perioperative outcomes after combined thoracoscomic-laparoscopic esophagec-tomy and open Ivor-lewis esophagectomy. Am J Sury, 2010, 199(5): 594-598.
4.	胡振東, 徐林, 馮純偉等. 食管癌左胸徑路全縱膈. 中華胸心血管外科雜志, 2009, 25(3): 202.
5.	Sun ZG, Wang Z. Clinical study on lymph node metastatic recurrence in patients with N0 esophageal squamous cell cancer. Dis Esophagus, 2011, 24(3): 182-188.
6.	Nsgatani S, Shimada Y, Kondo M, et al. A strategy for determing which thoracic esophageal cancer patients should undergo cervical lymph node dissection. Ann Thorac Surg, 2005, 80(5): 1881-1886.
7.	夏李明, 陳奇勛, 周星明, 等. 胸段食管癌喉返神經旁淋巴轉移的影響因素. 中國腫瘤, 2006, 15(11): 782-784.
8.	Osugi H, Takemura M, Higashino M, et al. Learning curve of video-assisted thoracoscopic esophagectomy and extensive lymphade-nectomy for squamous cell cancer of the thoracic esophagus and re-suits. Surg Endosc, 2003, 17: 515-519.
9.	張真銘, 王允, 高永山等. 微創手術治療食管癌160例臨床分析. 中華胃腸外科雜志, 2012, 9: 934-937.
10.	Avendano CE, Flume PA, Silvestri GA, et a1. Pulmonary complications after esophagectomy. Ann Thorac Surg, 2002, 73: 922-926.
11.	龔太乾, 蔣耀光, 王如文等. 食管癌術后早期并發癥及死亡原因分析. 中國胸心血管外科臨床雜志, 2005, 12: 173-176.
12.	Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg, 2012, 256: 95-103.
13.	Rizk NP, Bach PB, Schrag D, et al. The impact of complications on outcomes after resection for esophageal and gastroesophageal junction carcinoma. J Am Coil Surg, 2004, 198: 42-50.
14.	Guo W, Zhao YP, Jiang YG, et al. Prevention of postoperative chylothorax with thoracic duct ligation during video-assisted thoracoscopic esophagectomy for cancer. Surg Endosc, 2012, 26: 1332-1336.
15.	郭明, 胡蒙, 孫曉雁, 等. 全胸腔鏡聯合非氣腹腹腔鏡輔助食管癌根治術與常規手術的對比研究. 中國微創外科雜志, 2012, 12(1): 53-56.
16.	Whooley BP, Law S, Alexandrou A, et al. Critical appraisal of the significance of intrathoracic anastomotic leakage after esophagectomy for cancer. Am J Surg, 2001, 181(3): 198-203.
17.	Mailer JM, Erasmi H, Stelzner M, et al. Surgical therapy of oeso-phageal carcinoma. Br J Surg, 1990, 77: 845-857.
18.	Patil PK, Patel SG, Mistry RC, et al. Cancer of the esophagus in young adults. J Surg Oncol, 1992, 50(3): 179-182.
19.	De Martino RR, Goodney PP, Spangler EL, et al. Variation in throm boembolic complications among patients undergoing commonly performed cancer operations. J Vasc Surg, 2012, 55(4): 1035-1040.
20.	朱成楚, 陳仕林, 葉敏華, 等. 電視胸腔鏡下行食管癌手術胸部淋巴結清掃. 中華外科雜志, 2005, 43(10): 628-630.

1. 鄒小農, 陳萬青, 張思維, 等. 中國部分市縣1998-2002年食管發病與死亡. 中國腫瘤, 2007, 16(3): 142-146.
2. 陳龍奇. 食管癌國際TNM分期解讀與評價.中華腫瘤雜志, 2010, 32(3): 237-240.
3. Pham TH, Perry KA, Dolan JP, et al. Comparison of perioperative outcomes after combined thoracoscomic-laparoscopic esophagec-tomy and open Ivor-lewis esophagectomy. Am J Sury, 2010, 199(5): 594-598.
4. 胡振東, 徐林, 馮純偉等. 食管癌左胸徑路全縱膈. 中華胸心血管外科雜志, 2009, 25(3): 202.
5. Sun ZG, Wang Z. Clinical study on lymph node metastatic recurrence in patients with N0 esophageal squamous cell cancer. Dis Esophagus, 2011, 24(3): 182-188.
6. Nsgatani S, Shimada Y, Kondo M, et al. A strategy for determing which thoracic esophageal cancer patients should undergo cervical lymph node dissection. Ann Thorac Surg, 2005, 80(5): 1881-1886.
7. 夏李明, 陳奇勛, 周星明, 等. 胸段食管癌喉返神經旁淋巴轉移的影響因素. 中國腫瘤, 2006, 15(11): 782-784.
8. Osugi H, Takemura M, Higashino M, et al. Learning curve of video-assisted thoracoscopic esophagectomy and extensive lymphade-nectomy for squamous cell cancer of the thoracic esophagus and re-suits. Surg Endosc, 2003, 17: 515-519.
9. 張真銘, 王允, 高永山等. 微創手術治療食管癌160例臨床分析. 中華胃腸外科雜志, 2012, 9: 934-937.
10. Avendano CE, Flume PA, Silvestri GA, et a1. Pulmonary complications after esophagectomy. Ann Thorac Surg, 2002, 73: 922-926.
11. 龔太乾, 蔣耀光, 王如文等. 食管癌術后早期并發癥及死亡原因分析. 中國胸心血管外科臨床雜志, 2005, 12: 173-176.
12. Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg, 2012, 256: 95-103.
13. Rizk NP, Bach PB, Schrag D, et al. The impact of complications on outcomes after resection for esophageal and gastroesophageal junction carcinoma. J Am Coil Surg, 2004, 198: 42-50.
14. Guo W, Zhao YP, Jiang YG, et al. Prevention of postoperative chylothorax with thoracic duct ligation during video-assisted thoracoscopic esophagectomy for cancer. Surg Endosc, 2012, 26: 1332-1336.
15. 郭明, 胡蒙, 孫曉雁, 等. 全胸腔鏡聯合非氣腹腹腔鏡輔助食管癌根治術與常規手術的對比研究. 中國微創外科雜志, 2012, 12(1): 53-56.
16. Whooley BP, Law S, Alexandrou A, et al. Critical appraisal of the significance of intrathoracic anastomotic leakage after esophagectomy for cancer. Am J Surg, 2001, 181(3): 198-203.
17. Mailer JM, Erasmi H, Stelzner M, et al. Surgical therapy of oeso-phageal carcinoma. Br J Surg, 1990, 77: 845-857.
18. Patil PK, Patel SG, Mistry RC, et al. Cancer of the esophagus in young adults. J Surg Oncol, 1992, 50(3): 179-182.
19. De Martino RR, Goodney PP, Spangler EL, et al. Variation in throm boembolic complications among patients undergoing commonly performed cancer operations. J Vasc Surg, 2012, 55(4): 1035-1040.
20. 朱成楚, 陳仕林, 葉敏華, 等. 電視胸腔鏡下行食管癌手術胸部淋巴結清掃. 中華外科雜志, 2005, 43(10): 628-630.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis, Prevention and Treatment of Complications of 165 Patients with Thoracoscopic Esophagectomy

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