Evaluation of Postoperative Morbidity in Video-Assisted Thoracoscopic Surgery for Esophagectomy (VATS-E)

We evaluated the postoperative morbidity of esophagectomy with the aid of a thoracoscope (VATS-E) compared to conventional thoracotomical esophagectomy for esophageal cancer, from the viewpoint of systemic inflammatory response syndrome (SIRS) by assessing postoperative clinical parameters and changes in inflammatory cytokines. The thoracic operation time and the amount of bleeding in VATS-E were lower than in the conventional esophagectomy with open thoracotomy. In addition to being a less invasive procedure, VATS-E enabled the patients to become mobile and to start oral intake of food early after surgery. These differences in the postoperative recovery course were clearly reflected in SIRS. In the VATS-E group, the patients recovered from SIRS by the 3rd day after surgery, whereas SIRS tended to be prolonged in patients treated by the conventional esophagectomy by open thoracotomy. The postoperative changes in the level of interleukin 6 (IL-6), an inflammatory cytokine, reflected the differences in surgical stresses between the two groups. These results suggest that long-term elevated IL-6 levels might cause postoperative complications, leading to severe SIRS and organ failure. VATS-E is considered to be a less invasive and safer technique than esophagectomy with open thoracotomy from the viewpoint of the postoperative QOL, including the perioperative care of patients.