Vagal-sparing Minimally Invasive Esophagectomy with Two-field Lymphadenectomy for Esophageal Carcinoma: Is It a Possible and Useful Alternative?

Ahmed M. Daoud, Zongfei Wang, Xianben Liu, Ruixiang Zhang, Yan Zheng, Haibo Sun, Shilei Liu, Xiankai Chen, Qi Liu, Yin Li

The affiliated cancer hospital of Zhengzhou university, Henan Cancer Hospital, Zhengzhou, China

Date, time and location: 2018.05.26 17:00, Congress Hall, 2F–C

Abstract

Objectives: Vagal-sparing esophagectomy has the advantage of curative tumour resection with better functional outcome and reduced postoperative morbidity. Minimally invasive techniques have added valuable benefits of avoiding morbidities associated with big thoracic and abdominal incisions. Previously, vagus nerve preservation was only described for early stages of esophageal carcinoma where lymph node dissection is unnecessary. We hereby tried to evaluate the feasibility of vagal-sparing minimally invasive esophagectomy along with two-field lymphadenectomy for early as well as more advanced T2 stage esophageal carcinoma. In addition, we evaluated its effect on reduction of postoperative diarrhea as one of the undesirable complications after traditional esophagectomy.

Methods: Retrospective analysis of clinical and surgical data of 31 consecutive patients who received vagal-sparing minimally invasive esophagectomy with two-field lymphadenectomy for esophageal cancer between March 2015 to October 2016. Patient outcomes and postoperative complications specifically postoperative diarrhea were evaluated.

Results: The mean age was 60.55±7.907 year. 67.7% of the patients were males. Preoperative tissue diagnosis was squamous cell carcinoma in all patients. All the patients were operated by Professor Yin Li with vagal-sparing Minimally invasive esophagectomy and two-field lymphadenectomy with a mean number of lymph nodes dissected 28.65 ± 12.45 lymph nodes. Mean operative time was 248.55 minutes ± 43.7 minutes. Mean operative bleeding amount was 83.87 ml ± 47.52 ml. None of our patients needed ICU admission after surgery. Major postoperative complications were present in 19.35% of the patients. Postoperative diarrhea was only present in one patient (3.22%). Mean postoperative hospital stay was 9.94 days ± 3.89 day with no operative mortality among the included patients.

Conclusions:Our study results suggest that vagus nerve preservation is feasible with minimally invasive esophagectomy along with two-field lymphadenectomy and could reduce the postoperative diarrhea as one of the most frequent complications after esophagectomy.