Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2015; 21(37): 10675-10682
Published online Oct 7, 2015. doi: 10.3748/wjg.v21.i37.10675
Three-dimensional vs two-dimensional video assisted thoracoscopic esophagectomy for patients with esophageal cancer
Zhao Li, Jing-Pei Li, Xiong Qin, Bin-Bin Xu, Yu-Dong Han, Si-Da Liu, Wen-Zhuo Zhu, Ming-Zheng Peng, Qiang Lin
Zhao Li, Xiong Qin, Bin-Bin Xu, Yu-Dong Han, Si-Da Liu, Wen-Zhuo Zhu, Ming-Zheng Peng, Qiang Lin, Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200080, China
Jing-Pei Li, Department of Thoracic Surgery, Guangzhou Medical University First Affiliated Hospital, Guangzhou 510120, Guangdong Province, China
Author contributions: Li Z and Li JP contributed equally to this work; Li Z, Li JP and Xu BB collected and analyzed the data; Li Z and Qin X drafted the manuscript; Han YD and Liu SD provided analytical oversight; Peng MZ offered technical and material support; Li Z and Lin Q supervised the study and provided administrative support; all authors have read and approved the final version to be published.
Institutional review board statement: This study was approved by the Clinical Ethics Committee of Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No conflict of interest is declared.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Qiang Lin, MD, Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 100 Hai Ning Road, Shanghai 200080, China. xklinqiang@hotmail.com
Telephone: +86-21-36123602
Received: April 20, 2015
Peer-review started: April 21, 2015
First decision: June 19, 2015
Revised: July 8, 2015
Accepted: August 31, 2015
Article in press: August 31, 2015
Published online: October 7, 2015
Processing time: 161 Days and 16.6 Hours
Abstract

AIM: To define the benefits of three-dimensional video-assisted thoracoscopic esophagectomy (3D-VATE) over 2D-VATE for esophageal cancer.

METHODS: A total of 93 patients with esophageal cancer including 45 patients receiving 3D-VATE and 48 receiving 2D-VATE were evaluated. Data related to patient and cancer characteristics, operating time, intraoperative bleeding, morbidity and mortality, postoperative inflammatory markers, Numerical Rating Scale for postoperative pain, Constant-Murley rating system for shoulder recovery and oxygenation index (OI) were collected. All medical records were retrieved from a prospectively maintained oncological database at our institution. A retrospective study was performed to compare the short-term surgical outcomes between the two groups.

RESULTS: No significant differences were found between the two groups in either morbidity or mortality (P = 0.328). An enhanced surgical recovery was noted in the 3D group as indicated by shortened thoracoscopic operation time (3D vs 2D: 68 ± 13.79 min vs 83 ± 13 min, P < 0.01), minor intraoperative blood loss (3D vs 2D: 68.2 ± 10.7 mL vs 89.8 ± 10.4 mL, P < 0.01), earlier chest tube removal (3D vs 2D: 2.67 ± 1.01 vs 3.75 ± 1.15 d, P < 0.01), shorter length of hospital stay (3D vs 2D: 9.07 ± 2.00 vs 10.85 ± 3.40 d, P < 0.01), lower in-hospital expenses (3D vs 2D: 74968.4 ± 9637.8 vs 86211.1 ± 8519.7 RMB, P < 0.01), lower pain intensity (P < 0.01) and faster recovery of the left shoulder function (P < 0.01). Better preservation of the pulmonary function was also found in the 3D group as the decline of the OI post operation was significantly lower than that of the 2D group (P < 0.01). Changes of postoperative inflammatory markers, including procalcitonin [postoperative days (PODs) 4 and 7: P < 0.01], peripheral granulocytes (PODs 1, 4 and 7: P < 0.01) and hypersensitive C-reactive protein (POD 4: P < 0.01) in 3D-VATE patients were less than those in the 2D group. Moreover, utilization of the 3D technique extended the dissection of the thoracic lymph nodes (P < 0.01), with better exposure of nodes in the left recurrent laryngeal nerve (P = 0.031).

CONCLUSION: 3D-VATE could be a more viable technique over 2D-VATE in terms of short-term outcomes for patients with esophageal cancer.

Keywords: Esophageal cancer; Three-dimensional video-assisted thoracoscopic esophagectomy; Two-dimensional video-assisted thoracoscopic esophagectomy; Surgical outcomes

Core tip: Minimally invasive esophagectomy has been the predominant option for esophageal cancers. However, conventional two-dimensional video-assisted thoracoscopic esophagectomy (2D-VATE) is limited in its operating fields and disturbed eye-hand coordination, which may hamper necessary lymph node dissection and increase chances of surgical-related trauma. The introduction of 3D-VATE with 24-fold magnified view is designed to overcome such disadvantages. However, the benefits of 3D-VATE over 2D-VATE have not been fully studied in terms of surgical outcomes. This work, to our knowledge, is for the first time to report the definitive advantages of 3D-VATE in short-term outcomes.