ObjectiveTo investigate the short-term outcomes and quality of life (QoL) in patients undergoing minimally invasive McKeown esophagectomy with the assistance of near-infrared fluorescence imaging (NIRF). MethodsThis retrospective study included consecutive patients who underwent minimally invasive McKeown esophagectomy performed by a single surgical team at the Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, between July 2020 and December 2023. Patients were divided into two groups based on whether NIRF was used to assess gastric conduit perfusion: the NIRF group and the control group. Clinical characteristics, perioperative data, major postoperative complications, and short-term QoL were compared between the two groups. ResultsA total of 246 patients were included. The NIRF group comprised 132 patients, including 85 males and 47 females with a mean age of (62.6±6.7) years, and the control group consisted of 114 patients, including 78 males and 36 females with a mean age of (64.4±3.8) years. No significant differences were observed between the two groups in terms of operative time, intraoperative blood loss, number of dissected lymph nodes, or length of hospital stay (all P>0.05). There were also no significant differences in the rates of recurrent laryngeal nerve injury, cardiopulmonary complications, chylothorax, and 90-day mortality (all P>0.05). The incidence of anastomotic leakage was 3.7% in the NIRF group, lower than the 7.8% in the control group. Receiver operating characteristic (ROC) curve analysis, generated from software-assisted fluorescence intensity data, indicated that maximum fluorescence intensity (MFI) was associated with gastric conduit perfusion. An MFI of 20.5 was determined as the optimal cut-off value for predicting anastomotic leakage (P<0.05). Further analysis within the NIRF group showed that a fluorescence appearance time >95 s and a flow velocity <1.7 cm/s were significantly associated with an increased risk of anastomotic leakage (P<0.05). Regarding QoL, the SF-36 scores at 3 months postoperatively were significantly better in the NIRF group than in the control group (P<0.05). However, no significant difference was observed between the two groups at 12 months postoperatively (P>0.05). Conclusion The use of NIRF during minimally invasive esophagectomy provides an effective method for assessing gastric conduit perfusion via quantitative parameters. It significantly reduces the incidence of anastomotic leakage, thereby accelerating early postoperative recovery and improving short-term QoL.
Objective
To evaluate the clinical role of video-assisted mediastinoscopy and its safety and effectiveness in the diagnosis of thoracic disease.
Methods
We reviewed the clinical data of consecutive 40 patients (25 males and 15 females with an average age of 54.6 years) who received video-assisted mediastinoscopic surgery in our department of thoracic surgery from December 2011 to November 2016, including mediastinal lymph node biopsy in 27 patients, mediastinal primary lesions biopsy in 8, bronchial cystectomy in 3 and esophageal dissection in 2.
Results
The histological results were positive in 20 patients (73.1%) in mediastinal lymph node biopsy, including granulomatous mediastinitis in 14 and metastasis in 6 (non-small cell lung cancer in 4, Ewing sacoma in 1 and small cell lung cancer in 1) and reactive proliferation in 7 (26.9%). In mediastinal primary lesions biopsy, the accuracy rate of diagnosis was 100.0%. The pathologic results were malignant in all patients, including small cell lung cancer in 5, adenoid cystic carcinoma in 1, squamous carcinoma in 1 and adenocarcinoma in 1. In patients who received the bronchial cystectomy, no recurrence was found during at least 2 years follow-up. There was one patient with severe complication (innominate artery injury). Two patients suffered transient laryngeal recurrent nerve palsy with hoarseness and two patients incision secretion.
Conclusion
Video-assisted mediastinoscopic surgery is effective and safe and dissection should be careful in granulomatous mediastinitis to avoid the great vessel injures.
ObjectiveTo compare and analyze the short-term efficacy of different surgical methods for Siewert type Ⅰ and type Ⅱ esophagogastric junction carcinoma.MethodsWe selected 82 patients who accepted radical resection of esophagogastric junction carcinoma from March 2015 to March 2018 in our department, including 53 males and 29 females, aged 48-72 (61±6) years. The patients were divided into four groups according to the surgical method: a left thoracotomy group (n=14), a laparoscopic left small thoracotomy group (n=33), a thoracoscopic Ivor-Lewis group (n=17), and a thoracoscopic McKeown group (n=18). Their clinical characteristics, operative situations, postoperative complications and survival rate were analyzed.ResultsAmong the four groups, the left thoracotomy group cost the shortest operation time, followed by laparoscopic left small thoracotomy group, thoracoscopic McKeown group and thoracoscopic Ivor-Lewis group. The thoracoscopic McKeown group/laparoscopic left small thoracotomy group had the least bleeding. The fewest lymph nodes were dissected in the left thoracotomy group and the most in the thoracoscopic??????? McKeown group. The laparoscopic left small thoracotomy group had the lowest total complication rate and the incidence of pneumonia and arrhythmia among the four groups (P<0.05). There was no significant difference in survival rate among the four groups (P>0.05).ConclusionFor Siewert type Ⅰ and type Ⅱ esophagogastric junction carcinoma, thoracoscopy combined with laparoscopic radical resection is safe and reliable. Laparoscopic left small thoracotomy has the advantages of minimal invasiveness and complete lymph node dissection, especially for the patients with poor cardiopulmonary function, which will significantly shorten operation time and reduce postoperative complications, so it is worth to be popularized.
Objective To investigate the safety and feasibility of day surgery for patients with palmar hyperhidrosis based on the principles of enhanced recovery after surgery (ERAS). Methods We retrospectively reviewed the medical records of consecutive patients who underwent endoscopic thoracic sympathicotomy (ETS) in the First Affiliated Hospital of Xi'an Jiaotong University from March 2020 to December 2021. Patients were divided into a day surgery group and a conventional group according to their perioperative management methods. The patients in the day surgery group underwent an optimized perioperative procedure under the guidance of ERAS, and were ventilated with a laryngeal or face mask during the operation. The patients in the conventional group completed the preoperative examination, operation and postoperative observation according to the conventional procedures, and were intubated with a single-lumen endotracheal tube. The demographic characteristics, operation time, hospital stay, postoperative complications, and hospitalization cost were compared between the two groups. Results Finally 172 patients were collected, including 90 males and 82 females, with an average age of 25.97±7.43 years. There were 86 patients in each group. All patients ceased suffering from palmar sweating after surgery. No patient experienced massive bleeding or conversion to thoracotomy. There was no statistical difference in operation time between the two groups (P=0.534). Patients in the day surgery group were discharged within 24 hours. The average hospital stay in the conventional group was 2.09±0.41 days. Incidence of postoperative respiratory complications, and the hospitalization cost of the day surgery group were significantly lower than those of the conventional group (P＜0.001). The satisfaction rate in both groups was greater than 95%. Conclusion Day surgery for patients with palmar hyperhidrosis based on the principles of ERAS is safe and feasible, which can reduce postoperative complications, shorten the length of hospital stay and save the cost of hospitalization.
