Single-port Thoracoscopic Minimally Invasive Esophagectomy for Esophageal Cancer

Yong Yuan, Long-Qi Chen

West China Hospital of Sichuan University, Chengdu, China

Date, time and location: 2018.05.25 13:30, Congress Hall, 2F–C

Abstract

Objectives

To explore the feasibility and the potential advantages of single-port thoracoscopic esophagectomy over multi-port minimally invasive approach.

Methods

A propensity-matched comparison was made between the single-port and four-port thoracoscopic esophagectomy groups. Operative, perioperative data and postoperative pain scores (evaluated by visual analog scale) were compared between groups. For single-port thoracoscopic esophagectomy,  a 4-cm incision through the 4^th-5^th intercostal space was taken on the postaxillary line. Mobilization of stomach was conducted via multiple-port laparoscopic approach. Cervical end-to-side anastomosis was completed by hand-sewn procedures. 

Results

From 2014 to 2016, 56 matched patients were analyzed. There was no conversion to open surgery or operative mortality. The use of single-port thoracoscopic esophagectomy increased the length of operation time in comparison with using multiple-port minimally invasive technique (mean, 257 vs. 216 min, p = 0.026). The time taken for thoracic procedure in the single-port group was significant longer that in the multi-port group (mean, 126 vs. 84 min, p < 0.001). There were no significant differences between groups in the number of lymph nodes dissected, blood loss, complications or hospital stay (p > 0.05). In single-port thoracoscopic group, the pain in the abdomen was more severe than that in the chest (p = 0.042). The pain scores for postoperative day 1 and day 7 were significantly lower in the single-port group as compared with multiple-port group (p=0.038 and p < 0.001), a similar trend could be seen for the pain score on postoperative day 3 (p=0.058).

Conclusion

Single-port thoracoscopic esophagectomy contributes to reducing postoperative pain with an acceptable increase of operation time, which does not compromise surgical radicality and has similar short-term postoperative outcomes when compared with multiple-port minimally invasive approach.