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Surg Endosc. 2018 Feb;32(2):651-659. doi: 10.1007/s00464-017-5716-5. Epub 2017 Aug 4.

Impact of laparoscopy on the prevention of pulmonary complications after thoracoscopic esophagectomy using data from JCOG0502: a prospective multicenter study.

Nozaki I1,2, Mizusawa J3,4, Kato K3,5, Igaki H3,6, Ito Y3,7, Daiko H3,8, Yano M3,9, Udagawa H3,10, Nakagawa S3,11, Takagi M3,12, Kitagawa Y3,13.

Author information

1
Japan Esophageal Oncology Group of Japan Clinical Oncology Group (JCOG), Tokyo, Japan. isnozaki@shikoku-cc.go.jp.
2
Department of Surgery, Shikoku Cancer Center Hospital, 160 Minami-umemoto, Matsuyama, 791-0280, Japan. isnozaki@shikoku-cc.go.jp.
3
Japan Esophageal Oncology Group of Japan Clinical Oncology Group (JCOG), Tokyo, Japan.
4
Japan Clinical Oncology Group Data Center, National Cancer Center, Tokyo, Japan.
5
Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan.
6
Esophageal Surgery Division, National Cancer Center Hospital, Tokyo, Japan.
7
Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.
8
Esophageal Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan.
9
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
10
Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
11
Department of Surgery, Niigata Cancer Center Hospital, Niigata, Japan.
12
Department of Surgery, Shizuoka General Hospital, Shizuoka, Japan.
13
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.

Abstract

BACKGROUND:

Postoperative pulmonary complications (PPCs) are the most common causes of serious morbidity after esophagectomy, which involves both thoracic and abdominal incisions. Although the thoracoscopic approach decreases PPC frequency after esophagectomy, it remains unclear whether the frequency is further decreased by combining it with laparoscopic gastric mobilization. This study aimed to determine the impact of laparoscopy on the prevention of PPCs after thoracoscopic esophagectomy using data from the Japan Clinical Oncology Group Study 0502 (JCOG0502).

METHODS:

JCOG0502 is a four-arm prospective study comparing esophagectomy with definitive chemo-radiotherapy. The use of thoracoscopy and/or laparoscopy was decided at the surgeon's discretion. PPCs were defined as one or more of the following postoperative morbidities grade ≥2 (as per Common Terminology Criteria for Adverse Events v3.0): pneumonia, atelectasis, and acute respiratory distress syndrome.

RESULTS:

A total of 379 patients were enrolled in JCOG0502. Of these, 210 patients underwent esophagectomy via thoracotomy with laparotomy (n = 102), thoracotomy with laparoscopy (n = 7), thoracoscopy with laparotomy (n = 43), and thoracoscopy with laparoscopy (n = 58). PPC frequency was reduced to a greater extent by thoracoscopy than by thoracotomy (thoracoscopy 15.8%, thoracotomy 30.3%; p = 0.015). However, following thoracoscopic esophagectomy, laparoscopy failed to further decrease the PPC frequency compared with laparotomy (laparoscopy 15.5%, laparotomy 16.3%; p = 1.00). Univariable analysis showed that thoracoscopy (shown above) and less blood loss (<350 mL 16.3%, ≥350 mL 30.2%; p = 0.022) were associated with PPC prevention, whereas laparoscopy showed a borderline significant association (laparoscopy 15.4%, laparotomy 26.9%; p = 0.079). Multivariable analysis also showed that thoracoscopy and less blood loss were associated with PPC prevention.

CONCLUSION:

Thoracoscopic approach to esophagectomy significantly reduced PPC frequency with minimal additional effect from laparoscopic gastric mobilization.

KEYWORDS:

Esophageal cancer; Laparoscopy; Minimally invasive esophagectomy; Pneumonia; Thoracoscopy

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