Outcomes of the Modified Thoracoscopic En-bloc Esophagectomy in Patients with Esophageal Cancer

Abstract

Background: Esophageal cancer is one of the most prevalent types of cancer and causes of death worldwide. As the mainstream treatment, surgical resection is technically demanding and time-consuming. Therefore, the scope of its application is limited in the clinical setting. A new surgical approach is thus needed for an improved surgical effect and the prognosis of esophageal cancer. Objectives: This study aimed to investigate the effect of a modified thoracoscopic en-bloc esophagectomy on the removal of patients’ esophageal cancers and its outcomes. Methods: In this study, a modified en-bloc esophagectomy was developed to remove esophageal cancer. Patients who underwent the modified en-bloc esophagectomy by right thoracoscopic approach or thoracoscope-assisted small incisional approach to have their esophageal cancers removed in Peking University First Hospital (Beijing, China) between January 2014 and January 2017, were screened and retrospectively studied. Cancer recurrence, overall survival, mortality, as well as intraoperative and postoperative outcomes, were reported. Results: A total of 31 patients (22 male and 9 female, mean age: 62.9 years) were included in the study. Out of 30 patients with R0 resection, eight patients had cancer recurrences in the neck, lung, liver, and bone; however, none of the recurrences was identified in the mediastinum. Six patients died during the follow-up period. By the end of December 2020, the five-year survival rate of all patients was 58.3%. The median survival time of N0 patients was 52 months, which was significantly longer than that in N1+2 patients (23 months). Additionally, there was no statistically significant difference between the median survival time of N1 and N2 patients. Moreover, perioperative complications included pneumonia, arrhythmia, hoarseness, and chylous ascites, which were consistent with those reported previously. Conclusion: The modified en-bloc esophagectomy to remove esophageal cancer by right thoracoscopic approach or thoracoscope-assisted small incisional approach was found safe and reliable due to decreased cancer recurrence, increased overall survival rate, and prolonged survival time.