Abstract：Objective This study aimed to explore the efficacy of the esophageal bed pathway and the retrosternal pathway on thoracoscopic resection of esophageal cancer. Methods A total of 116 patients with esophageal cancer in Nanshi Hospital of Nanyang were included between January 2018 and January 2022 for a retrospective cohort study. Among the patients, 69 were male and 47 were female [aged 45-67 (56.5±5.5) years old], with 26, 67, and 23 having stage Ⅰ, Ⅱ, and Ⅲ esophageal cancer, respectively. All 116 patients underwent thoracoscopic resection of esophageal cancer, and they were divided into two groups according to different surgical pathways, including 58 patients with thoracoscopic resection of esophageal cancer via esophageal bed pathway (esophageal bed group) and 58 patients with thoracoscopic resection of esophageal cancer via the retrosternal pathway (retrosternal group). The observation indicators were as follows. (1) Baseline data such as gender, age, course of disease, tumor type, tumor location, and comorbidities were compared between the two groups. (2) Surgical time, intraoperative blood loss, postoperative indwelling time of drainage tube, total gastric fluid drainage volume, and occurrence of complications such as postoperative incision infection, pulmonary infection, chylothorax, anastomotic fistula, and arrhythmia were compared between the two groups. (3) Standardized swallowing assessment (SSA), Burke dysphagia screening scale (Burke score), and X-ray video-fluoroscopy swallowing study (VFSS) were used to evaluate and compare the swallowing function in the two groups before surgery and 3 months after. (4) The total score and scores of items of quality of life 3 months after were compared between the two groups. (5) The recurrence, metastasis, and survival of the two groups were compared during follow-up. Results (1) No statistically significant differences existed in baseline data between the two groups (all P values>0.05). (2) All 116 patients successfully completed the surgery, and no statistical differences existed in the surgical time and intraoperative blood loss (t=1.50,1.20,all P values >0.05). The total postoperative gastric fluid drainage volume with (349.7±41.9) mL in the retrosternal group was smaller than that (736.2±52.1) mL in the esophageal bed group. The incidence rate of anastomotic fistula with 13.8% (8/58) was higher than 1.7% (1/58) in the esophageal bed group, and the differences were statistically significant (t=44.03,χ2=4.34,all P values <0.05). There were no statistical differences existed in the postoperative drainage indwelling time and incidence rates of complications such as pulmonary infection, chylothorax, and arrhythmia between the two groups (all P values >0.05). (3) All 116 patients were followed up for 3-12 (7.3±1.5) months. The scores of swallowing function SSA, Burke, and VFSS 3 months after were (24.2±1.2), (2.5±0.3) points, and (7.2±0.9) points in the esophageal bed group, respectively. The corresponding scores in the retrosternal group were (24.5±1.2) points, (2.6±0.3) points, and (7.0±0.8) points, respectively. The SSA score and Burke score in the two groups 3 months after were lower than those before surgery, whereas the VFSS score was higher than that before surgery, and the differences were statistically significant (all P values <0.05). No statistically significant differences existed in the scores of SSA, Burke, and VFSS between the two groups before surgery and 3 months after (all P values >0.05). (4) No statistical differences existed in the total score and scores of items of quality of life between the two groups 3 months after (all P values >0.05). (5) Follow-up revealed 2 cases of recurrence and 1 of liver metastasis in the retrosternal group, and 1 case of recurrence, 1 of bone metastasis, and 1 of brain metastasis in the esophageal bed group. No statistically significant difference existed in the recurrence rate and metastasis rate between the two groups (χ2=0.51,0.00,all P values>0.05), and no death occurred in the two groups during follow-up. Conclusion Esophageal bed pathway and retrosternal pathway for thoracoscopic resection of esophageal cancer can achieve good tumor-treatment effects. Both can improve the swallowing function and enhance the quality of life of patients. Esophageal bed pathway has low incidence rate of anastomotic fistula, and retrosternal pathway has low total amount of gastric fluid drainage.
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Yu Dewang, Wang Dongfang, Jin Hongling, Wang Yan. Comparison of efficacy of esophageal bed pathway and retrosternal pathway on thoracoscopic resection of esophageal cancer. Chinese Journal of Anatomy and Clinics, 2023, 28(10): 672-678.
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2023, Vol. 28 
