Objective: To evaluate the
perioperative period and long-term effects of minimally invasive gasless laparoscopic transhiatal
esophagectomy (LTE) and minimally invasive combined thoracoscopic and laparoscopic
esophagectomy (CTLE) for stageⅠ-Ⅲ cervical
esophageal cancer. Methods: The clinical data of 158 consecutive patients with cervical
esophageal cancer stageⅠto Ⅲ who underwent minimally invasive CTLE or LTE
esophagectomy in the Department of Thoracic Surgery, Beijing Tongren Hospital from January 2008 to December 2019 were retrospectively analyzed. A total of 40 pairs of cases were matched (40 cases of CTLE and 40 cases of LTE surgery) after using the propensity score matching analysis which aimed to balance the influence of confounding factors between groups, including 43 males and 37 females, aged 51 to 81 (62.5±7.0) years old. The perioperative variables and long-term outcomes of the two groups were compared. Results: The operation time ((148.0±31.3) min vs (201.3±48.3) min), intraoperative blood loss ((192.6±77.9) ml vs (387.8±112.4) ml), ICU monitoring time (0 day vs 1 day), and the complication rates of postoperative
pneumonia (0 vs 15%) and
arrhythmia (2.5% vs 20%) were lower in the LTE group than that of in the CTLE group(all P<0.05). The number of
lymph node dissections in the CTLE group was higher than that of in the LTE group (21.2±6.1 vs 12.9±4.3, P<0.001). The 3-and 5-year overall survival (OS) rate and disease-free survival (DFS) rate in the LTE group (OS: 53.53% and 34.27%, DFS: 43.62% and 24.89%, respectively) and the CTLE group (OS: 59.48% and 37.29%, DFS: 49.12% and 28.82%, respectively) had no statistical differences (all P>0.05). Conclusion: The LTE group has advantages in reducing operation time, intraoperative
bleeding, ICU monitoring time, postoperative incidence of
pneumonia and
arrhythmia, and its long-term prognosis is comparable to that of the CTLE group.