食道癌に対する低侵襲手術と成績向上への取り組み ： 開胸手術から鏡視下手術(VATS-E)へ

Abstract

In this study we investigated the advantages of video-assisted thoracoscopic surgery for esophageal cancer (VATS). From 2001 to 2011, 110 cases were operated on for esophageal cancer in our department. We classified these cases into three groups : a conventional open surgery group (OS) (70 cases), a first half group (20 cases) for VATS and a second-half group (20 cases) for VATS (40 cases). There were no significant differences among the three groups in terms the patient characteristics and states of tumors. Operation times were long in the VATS groups than in the OS group. On the ohter hand, intraoperative blood loss was significantly less and the number of dissected lymph nodes was significantly increased in second-half group for VATS when compared with OS group. The incidence of all postoperative complications was significantly lower in the second-half group for VATS than in the OS group, especially those relating to the respiratory system. As a resutlt, the duration of ICU stay and postoperative hospital stay was shortened in the second-half group. We thought that the expansion effect of viewing with VATS brought about the reduction in the rate of complications and shortening of duration of hospitalization, due to the exact preservation of the vagus branch of the pulmonary plexus, recurrent laryngeal nerve or bronchial artery. Mastery of VATS is required to obtain these benefits.