A comparison of video-assisted thoracoscopic oesophagectomy and radical lymph node dissection for squamous cell cancer of the oesophagus with open operation

H Osugi, M Takemura, M Higashino, N Takada, S Lee, H Kinoshita
British Journal of Surgery 2003, 90 (1): 108-13

BACKGROUND: A direct comparison of open operation and video-assisted thoracoscopic surgery (VATS) for radical oesophagectomy has yet to be published.

METHODS: Medical records of 149 patients with oesophageal squamous cell carcinoma who underwent oesophagectomy and three-field lymphadenectomy were reviewed. Seventy-seven patients had the thoracic procedure performed via a 5-cm minithoracotomy and four ports (VATS group); the others were operated on by conventional posterolateral thoracotomy (open group).

RESULTS: The mean number of retrieved mediastinal nodes, blood loss and morbidity were similar in the VATS and open groups (33.9 versus 32.8 nodes, 284 versus 310 g, and 32 versus 38 per cent respectively). The thoracic procedure took longer in patients having VATS than in the control group (227 versus 186 min; P = 0.031). Vital capacity reduction was less with VATS than in the open group (15 versus 22 per cent; P = 0.016). The 3- and 5-year survival rates were similar: 70 and 55 per cent respectively for VATS compared with 60 and 57 per cent for the open procedure.

CONCLUSION: VATS provides comparable results to open radical oesophagectomy, with less surgical trauma.

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