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Cervical And Abdominal Uniport Esophagectomy For Esophageal Carcinoma: The First Internationally Reported Cohort Analysis
Xu Li, Jiazhou Xiao.
The First Affiliated Hospital of Fujian Medical University, FuZhou, China.
BACKGROUND:Despite advances in thoracoscopic and laparoscopic esophagectomy, the incidence of postoperative complications such as pneumonia remains high. Patients with compromised pulmonary function or those who have previously undergone right thoracic surgery are frequently deemed ineligible for this procedure due to the associated risks. To address these challenges, we have developed a cervical and abdominal uniport esophagectomy technique that integrates single-port laparoscopic technology into a mediastinoscopic approach, aiming to further reduce surgical trauma and expand eligibility criteria. This is the first report on a prospective study utilizing this innovative technique.
METHODS:This prospective study was performed for 125 patients diagnosed with esophageal squamous cell carcinoma (ESCC) who underwent cervical and abdominal uniport esophagectomy from January 2021 to January 2024. The primary endpoints included perioperative safety, operative metrics, and recovery parameters. Follow-up assessments were conducted every three months for the first two years post-discharge, focusing on late complications, functional recovery, quality of life, and survival rates.
RESULTS:All procedures were completed successfully using the technique, except for one conversion to open thoracotomy due to aggressive tumor characteristics and another due to bleeding from the splenic artery during laparoscopic stage. The mean operative time was 147 minutes, which is approximately 30% shorter than conventional hybrid approaches. Postoperative morbidity was observed in 35.3% of patients, most commonly pneumonia (7.35%). The 30-day mortality rate was 1.5%. Median length of hospital stay was 11.6 days. The overall survival rates at 1, 2, and 3 years were 95.6%, 91.0%, and 81.1%, respectively.
CONCLUSIONS:Our findings suggest that cervical and abdominal uniport esophagectomy is a safe and effective procedure for treating esophageal cancer, offering reduced surgical trauma, shorter operative times, and comparable oncological outcomes to conventional methods. This technique may be particularly beneficial for high-risk patients with severe pulmonary comorbidities or prior thoracic surgeries.LEGEND:A.The patient's position and incision during cervical and abdominal uniport esophagectomyB.The position of the cervical and abdominal installation sleeves in patients undergoing cervical and abdominal uniport esophagectomyC.Expose the left recurrent laryngeal nerve through a neck incisionD.Expose the right recurrent laryngeal nerve through a neck incisionE.Expose key blood vessels through abdominal incision.
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