Clinical efficacy of exclusive right-thoracic approach in esophageal surgery

Abstract

Objective To investigate the indications and clinical efficacy of an exclusive right-thoracic approach in esophageal surgery. Methods The clinical data of 35 patients with esophageal disease who underwent an exclusive right-thoracic approach operation from June 2008 to June 2010 at the Affiliated Hospital of Qingdao University were retrospectively analyzed. Of the 35 patients, 21 were with esophageal cancer, and their ages were above 70 years, the partial pressure of oxygen of arterial blood （ PaO2 ） , maximal voluntary ventilation and forced vital capacity of the first second were （70±9）mm Hg （1 mm Hg=0.133 kPa）, 51%±9% and 57%±11%, respectively. Fourteen patients were with benign esophageal disease or low grade malignancy, and their PaO2 maximal voluntary ventilation and forced vital capacity of the first second were （96 ± 13 ）mm Hg, 83 %± 11% and 91%± 14%, respectively. Exclusive right-thoracic approach was selected for all the patients, and surgical procedure was selected according to the location of the lesions. Patients were followed up by out-patient examination or phone call till April 2012. Results All the operations were carried out successfully, 21 patients with esophageal cancer underwent partial esophagus resection and stomach-esophagus intrathoracic anastomosis through a right-thoracic approach. Of the 14 patients with benign esophageal disease or low grade malignancy, 2 patients were with esophageal leiomyoma, 3 with esophageal stromal tumor and 1 with esophageal leiomyomatosis underwent partial esophagus resection ± intrathoracic anastomosis ; 7 patients with esophageal leiomyoma and 1 with esophageal stromal tumor underwent tumor extirpation. The operation time and operative blood loss were （3.4 ± 1.8）hours and （160±44） ml, respectively. The number of lymph node dissected of the 21 patients withesophageal tumor was 14 ± 5, including 1. 1 ± 0. 7 lymph nodes dissected near the left gastric artery. No anastomosis fistula and perioperative death were detected, and the duration of hospital stay was （ 10±4） days. The postoperative PaO2 , maximal voluntary ventilation and forced vital capacity of the first second were （66 ± 10） mm Hg, 50% ± 11% and 51% ± 15% for patients with esophageal cancer, and （94 ± 13） mm Hg, 80% ± 13% and 87% ± 16% for patients with benign esophageal disease or low grade malignancy. All the patients were followed up for 1-2 years, no eating obstruction was detected, and the postoperative 1- and 2-year survival rate were 82.9% （29/35） and 77.1% （27/35）, respectively. Of the 8 patients with esophageal cancer who died postoperatively, 1 died of cardiovascular diseases and 7 died of tumor recurrence and metastasis. Conclusion Exclusive rightthoracic appraoch could be used for patients with benign esophageal disease, low-grade malignancy and old esophageal cancer patients with poor oulmonarv function. Key words: Esophageal neoplasms; Surgical approach, exclusive right thoracic incision; Efficacy