Thoracolaparoscopic esophagectomy and open surgery for different pathological stages of esophageal cancer: a comparison of short-term efficacy

Objective To investigate the effect of minimally invasive thoracolaparoscopic or open esophagectomy on the short-term prognosis of esophageal cancer with different pathological stages and provide clinical experience for surgical selection for the patients. Methods A retrospective analysis was performed on the clinical data of 280 patients undergoing radical resection due to esophageal cancer in our department from January 2017 to December 2018. According to the surgical approaches, they were divided into minimal invasive group (MI, n=81) and open surgery group (OS, n=199). The perioperative prognosis, postoperative complications, and short-term efficacy of 2 surgical methods for different pathological stages were compared between the 2 groups. Results For the totally 280 patients, postoperative pathological diagnosis identified 8 cases of stage 0, 43 cases of stage Ⅰ, 103 cases of stage Ⅱ, 106 cases of stage Ⅲ and 20 cases of stage Ⅳ. The MI group had a significantly longer operation time and less intraoperative blood loss when compared with the OS group (both P < 0.05). Though there was no statistical difference in postoperative hospital stay between the 2 groups (P>0.05), the time needed for postoperative diet recovery was obviously longer in the MI group (P < 0.05). The total incidences of postoperative complications were similar (P>0.05), but the patients of the MI group were prone to anastomotic fistula (P < 0.05), while those of the other group to pulmonary infection and pleural effusion (P < 0.05). Among the patients with different pathological stages of esophageal cancer, the operation time in the MI group was generally longer than that in the OS group (F=20.231, P < 0.05), while the pathological stage did not affected the operation time (F=1.300, P>0.05). The pathological stage and surgical approach had a joint effect on the postoperative diet recovery time and hospital stay time (main effect of interaction, P < 0.05). The patients with 0 or Ⅳ stage had a shorter recovery time than those with other stages (P < 0.05). For the Ⅳ stage patients who could not undergo radical resection but only underwent R0 resection, the minimally invasive surgery was more effective in shortening the postoperative diet recovery time and hospital stay time (P < 0.05). Conclusion Compared with OS, thoracolaparoscopic surgery has obvious advantages in reducing intraoperative bleeding and incidence of pulmonary complications. For the patients who cannot undergo radical (R0) resection, minimally invasive surgery can accelerate postoperative recovery, which is of great significance in performing continuous treatment as soon as possible, promoting the quality of life and prolonging the survival period of the patients.