Abstract 1379: A novel therapy for esophageal cancer: improved thoracoscopic esophagectomy and analysis of 361 cases.
Authors: Weimin Zhang, Jianbin Hou, Xiansheng Fan, Kefeng Shi, Ran Yang, Xiaodong Zheng, Wancai Yang
Journal: Cancer Research (2013)

Abstract Esophageal cancer is one of the common cancers worldwide, and Anyang and Linzhou areas in Northern China are the highest incidence areas of esophageal cancer. The prognosis is poor and five-year survival is very low. Several therapeutic strategies have been used for decades; esophagectomy is still the best way to treat esophageal cancer. In the past several years, a novel therapy for esophageal cancer - thoracoscopic esophagectomy has been developed, which has minimal invasion and less operative time and complications, compared to conventional esophagectomy, but there are also some limitations. This report is to introduce a modified thoracoscopic esophagectomy for esophageal cancer therapy recently developed in our hospitals. We also analyzed the outcomes of the 361 esophageal cancer patients. The widely used thoracoscopic esophagectomy needs two holes locating at the eighth and ninth intercostal, respectively, for observation and operation simultaneously. In our procedure, first, we put patient at prone position, we cut 4 holes, one 1-cm hole for observation is located at the 8th or 7th intercostal of right chest axillary line, one 2-cm hole for operation is located at the 9th or 8th intercostals of the subscapularis. Two additional holes are cut for auxiliary operation, one is located at 6th intercostals of subscapularis; another one is located at 4th intercostal of axillary line. The esophagus is separated using ultrasound knife, mediastinal lymph nodes are cleaned, thoracic duct is tied. Second, we put the patient into supine position, separate the stomach using a small cut right next to the midline of the upper abdomen, and make a tubular stomach. Finally, we cut a hole at the front of the right neck sternocleidomastoid, and connect the residual esophagus and stomach neck using anastomosis. We have used the modified method on 300 esophageal cancer patients. The operative time is 2 - 4 h, significantly reduced the operative time. Blood loss is between 100-400 ml. There are only 34 cases of post-operation complication, including 11 anastomosis leaking, 7 thoracic duct leaking, 7 recurrent laryngeal nerve injury, and 3 respiratory infection. No any death occurs. Conclusion: surgical esophagectomy is the first option for esophageal cancer, and the modified thoracoscopic esophagectomy with 4 holes provides more observation fields, facilitate dissection. The minimal invasive operation reduces operative time and hospital stay time, minimizes post-operation complication. Thus, the improved thoracoscopic esophagectomy will benefit to esophageal cancer patients, particularly to senior patients and the patients with poor physical conditions. The limitation is that this method is good for the patients without distance metastasis or obvious extra-esophagus invasion. Citation Format: Weimin Zhang, Jianbin Hou, Xiansheng Fan, Kefeng Shi, Ran Yang, Xiaodong Zheng, Wancai Yang. A novel therapy for esophageal cancer: improved thoracoscopic esophagectomy and analysis of 361 cases. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1379. doi:10.1158/1538-7445.AM2013-1379 Note: This abstract was not presented at the AACR Annual Meeting 2013 because the presenter was unable to attend.