Analysis of learning process of video-assisted minimally invasive esophagectomy for thoracic esophageal carcinoma

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Author:
XIE Xuan(Department of Thoracic Oncology, Cancer Center, Sun Yat-sen University, State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China)
FU Jian-hua(Department of Thoracic Oncology, Cancer Center, Sun Yat-sen University, State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China)
WANG Jun-ye(Department of Thoracic Oncology, Cancer Center, Sun Yat-sen University, State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China)
ZHANG Xu(Department of Thoracic Oncology, Cancer Center, Sun Yat-sen University, State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China)
LUO Kong-jia(Department of Thoracic Oncology, Cancer Center, Sun Yat-sen University, State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China)
YANG Fu(Department of Thoracic Oncology, Cancer Center, Sun Yat-sen University, State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China)
Amos Ela Bella(Department of Thoracic Oncology, Cancer Center, Sun Yat-sen University, State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China)
LI Xiao-hai(Department of Thoracic Oncology, Cancer Center, Sun Yat-sen University, State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China)
Journal Title:
Chinese Journal of Gastrointestinal Surgery
Issue:
Volume 15, Issue 09, 2012
DOI:
10.3760/cma.j.issn.1671-0274.2012.09.013
Key Word:
Esophageal neoplasms ; Esophagectomy ; Minimally invasive surgery ; Learning curve

Abstract: Objective To evaluate the learning process of video-assisted minimally invasive esophagectomy (MIE).Methods One hundred consecutive patients with thoracie esophageal carcinoma were treated by a same team of surgeons,and were divided into 3 groups in chronological order.The former two groups both consisted of 25 patients with thoracoscopy plus laparotomy.The remaining 50 patients were enrolled in the third group with thoracoscopy plus laparoscopy.Clinicopathological data including operative time,blood loss,protection of normal structures,complications,length of ICU stay,postoperative stay,and lymph nodes harvest,were collected and compared between groups.Results Procedures were accomplished successfully in 96 patients.Only 4 cases were converted to open thoracotomy and none to laparotomy.The median operative time was 310 min and blood loss was 200 ml.The median number of lymph node harvest was 22.The overall complication rate was 50%.Comparison of first two groups revealed that significant differenees existed in the preservation rate of arch of azygos vein (P=0.010),bronchial vessels (P=0.038),and exposure rate of thoracic part of left recurrent laryngeal nerve (P=0.048).Comparison of the former and latter 50 patients revealed that significant differences existed in thoracic operative time (P<0.001),blood loss (P=0.025),preservation rate of arch of azygos vein (P=0.001) and bronchial vessels (P<0.001),the number oF lymph node harvest in thoracoscopy(P=0.022) and in left recurrent l.aryngeal nerve chain(P<0.001 ),and exposure rate of initiate part of left recurrent laryngeal nerve (P=0.002).Conclusion The learning curve of MIE is long and beginners should proceed step by step.

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