Effect of drainage tube placed in left thoracic cavity versus placed in mediastinum after left pleura partial resection in robot-assisted McKeown esophagectomy for esophageal carcinoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Yang , PENG Hao , HU Liwen , QIN Tao , ZHONG Jihong , SHEN Yi ,  YI Jun

Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, P. R. China;

Corresponding author：

YI Jun, Email: njyijun@163.com

Keywords：

Esophageal cancer; mediastinal drainage tube; pleural effusion; Da Vinci surgical system; enhanced recovery after surgery

DOI：

10.7507/1007-4848.202112014

Video：

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Objective To evaluate the effect of mediastinal drainage tube placed in the left thoracic cavity after partial resection of the mediastinum pleura in robot-assisted McKeown esophagectomy for esophageal carcinoma, and to compare it with the traditional method of mediastinal drainage tube placed in mediastinum. Methods We retrospectively analyzed clinical data of 96 patients who underwent robot-assisted McKeown esophagectomy for esophageal carcinoma by the surgeons in the same medical group in our department between July 2018 and March 2021. There were 78 males and 18 females, aged 52-79 years. Left mediastinum pleura around the carcinoma during operation was resected in all patients. Patients were divided into two groups according to the method of mediastinal drainage tube placement: a control group (placed in mediastinum) and an observation group (placed through the mediastinal pleura into the left thoracic cavity with several side ports distributed in the mediastinum). The incidence of left thoracentesis or catheterization after surgery, anastomotic fistula and anastomotic healing time, other complications such as pneumonia and postoperative pain score were also compared between the two groups. Results There was no statistical difference in baseline data or surgical parameters between the two groups. The percentage of patients in the observation group who needed re-thoracentesis or re-catheterization postoperatively due to massive pleural effusion in the left thoracic cavity was significantly lower than that in the control group (5.6% vs. 21.4%, P=0.020). The incidence of anastomotic leakage (3.7% vs. 7.1%, P=0.651) and the healing time of anastomosis (18.56±4.27 d vs. 24.33±5.48 d, P=0.304) were not statistically different between the two groups, and there was no statistical difference in other complications such as pulmonary infection. Moreover, the postoperative pain score was also similar between the two groups. Conclusion For patients whose mediastinal pleura is removed partially during robot-assisted McKeown esophagectomy for esophageal carcinoma, placing the drainage tube through the mediastinal pleura into the left thoracic cavity can reduce the risk of left-side thoracentesis or catheterization, which may promote the postoperative recovery of patients.

Citation： XU Yang, PENG Hao, HU Liwen, QIN Tao, ZHONG Jihong, SHEN Yi, YI Jun. Effect of drainage tube placed in left thoracic cavity versus placed in mediastinum after left pleura partial resection in robot-assisted McKeown esophagectomy for esophageal carcinoma. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(9): 1140-1147. doi: 10.7507/1007-4848.202112014 Copy

1.	陈飞, 王悠清. 1990—2019年中国食管癌疾病负担及其变化趋势分析. 中国肿瘤, 2021, 30(6): 401-407.
2.	朱多杰, 李斌, 王成, 等. 术后辅助治疗对局部进展期(pT3N0M0)食管鳞癌远期生存影响的回顾性分析. 中国肿瘤临床, 2018, 45(5): 228-231.
3.	Watanabe M, Otake R, Kozuki R, et al. Recent progress in multidisciplinary treatment for patients with esophageal cancer. Surg Today, 2020, 50(1): 12-20.
4.	Maas KW, Cuesta MA, van Berge Henegouwen MI, et al. Quality of life and late complications after minimally invasive compared to open esophagectomy: Results of a randomized trial. World J Surg, 2015, 39(8): 1986-1993.
5.	Sakamoto T, Fujiogi M, Matsui H, et al. Comparing perioperative mortality and morbidity of minimally invasive esophagectomy versus open esophagectomy for esophageal cancer: A nationwide retrospective analysis. Ann Surg, 2021, 274(2): 324-330.
6.	Takeuchi H, Miyata H, Ozawa S, et al. Comparison of short-term outcomes between open and minimally invasive esophagectomy for esophageal cancer using a nationwide database in Japan. Ann Surg Oncol, 2017, 24(7): 1821-1827.
7.	易俊, 熊磊, 李德闽, 等. 达芬奇机器人在食管癌外科治疗中的应用. 中国胸心血管外科临床杂志, 2015, 22(10): 910-913.
8.	Tagkalos E, Goense L, Hoppe-Lotichius M, et al. Robot-assisted minimally invasive esophagectomy (RAMIE) compared to conventional minimally invasive esophagectomy (MIE) for esophageal cancer: A propensity-matched analysis. Dis Esophagus, 2020, 33(4): doz060.
9.	徐志华, 张含露, 杨梅, 等. 达芬奇机器人与胸腹腔镜联合辅助McKeown食管癌根治术后患者短期疼痛的非随机对照研究. 中国胸心血管外科临床杂志, 2018, 25(5): 378-381.
10.	刘继辉, 孙明, 余兵. 纵隔负压引流管在经右胸途径食管癌手术中的应用. 临床外科杂志, 2021, 29(8): 714-716.
11.	孙志勇, 曹子昂, 叶清, 等. 术前运用NRS2002评估食管癌患者营养风险及临床结局的研究. 中国胸心血管外科临床杂志, 2015, 22(4): 323-326.
12.	许淑华, 何祺煜, 王小军, 等. 胸腔镜食管癌术后常见并发症的比较分析. 东南大学学报 (医学版), 2021, 40(1): 74-77.
13.	Sziklavari Z, Neu R, Hofmann HS, et al. Persistent pleural effusion following thoracic surgery. Chirurg, 2015, 86(5): 432-436.
14.	Xu Y, Li XK, Cong ZZ, et al. Long-term outcomes of robotic-assisted versus thoraco-laparoscopic McKeown esophagectomy for esophageal cancer: A propensity score-matched study. Dis Esophagus, 2021, 34(9): doaa114.
15.	Nakahara Y, Yamasaki M, Miyazaki Y, et al. Reflux after esophagectomy with gastric conduit reconstruction in the posterior mediastinum for esophageal cancer: Original questionnaire and EORTC QLQ-C30 survey. Dis Esophagus, 2018, 31(7): 1-7.
16.	Quiding H, Häggquist SO. Visual analogue scale and the analysis of analgesic action. Eur J Clin Pharmacol, 1983, 24(4): 475-478.
17.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
18.	纪晨光, 刘丽, 冯志杰. 早期食管癌的内镜下诊治进展. 河北医科大学学报, 2021, 42(6): 735-739.
19.	侯广杰, 连戈, 郭宝峰, 等. 胸腹腔镜联合切除局部晚期食管癌手术视频要点. 中国胸心血管外科临床杂志, 2020, 27(6): 627-628.
20.	Sihag S, Ku GY, Tan KS, et al. Safety and feasibility of esophagectomy following combined immunotherapy and chemoradiotherapy for esophageal cancer. J Thorac Cardiovasc Surg, 2021, 161(3): 836-843.
21.	徐杨, 申翼. 达芬奇机器人在食管外科中的应用. 医学研究生学报, 2021, 34(1): 1-7.
22.	范富翠, 童雅萍, 梁冠冕, 等. NRS2002结合营养指标评价食管癌术后出院患者的营养状况. 广东医学, 2020, 41(19): 1970-1974.
23.	赵澜涛, 王亮, 陈建海, 等. 经纵隔右胸腔引流管在食管癌根治术后引流效果分析. 山西医药杂志, 2020, 49(4): 447-449.
24.	Marshall K, McLaughlin K. Pain management in thoracic surgery. Thorac Surg Clin, 2020, 30(3): 339-346.
25.	Ashok A, Niyogi D, Ranganathan P, et al. The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection. Surg Today, 2020, 50(4): 323-334.
26.	Rubinkiewicz M, Witowski J, Su M, et al. Enhanced recovery after surgery (ERAS) programs for esophagectomy. J Thorac Dis, 2019, 11(Suppl 5): S685-S691.

1. 陈飞, 王悠清. 1990—2019年中国食管癌疾病负担及其变化趋势分析. 中国肿瘤, 2021, 30(6): 401-407.
2. 朱多杰, 李斌, 王成, 等. 术后辅助治疗对局部进展期(pT3N0M0)食管鳞癌远期生存影响的回顾性分析. 中国肿瘤临床, 2018, 45(5): 228-231.
3. Watanabe M, Otake R, Kozuki R, et al. Recent progress in multidisciplinary treatment for patients with esophageal cancer. Surg Today, 2020, 50(1): 12-20.
4. Maas KW, Cuesta MA, van Berge Henegouwen MI, et al. Quality of life and late complications after minimally invasive compared to open esophagectomy: Results of a randomized trial. World J Surg, 2015, 39(8): 1986-1993.
5. Sakamoto T, Fujiogi M, Matsui H, et al. Comparing perioperative mortality and morbidity of minimally invasive esophagectomy versus open esophagectomy for esophageal cancer: A nationwide retrospective analysis. Ann Surg, 2021, 274(2): 324-330.
6. Takeuchi H, Miyata H, Ozawa S, et al. Comparison of short-term outcomes between open and minimally invasive esophagectomy for esophageal cancer using a nationwide database in Japan. Ann Surg Oncol, 2017, 24(7): 1821-1827.
7. 易俊, 熊磊, 李德闽, 等. 达芬奇机器人在食管癌外科治疗中的应用. 中国胸心血管外科临床杂志, 2015, 22(10): 910-913.
8. Tagkalos E, Goense L, Hoppe-Lotichius M, et al. Robot-assisted minimally invasive esophagectomy (RAMIE) compared to conventional minimally invasive esophagectomy (MIE) for esophageal cancer: A propensity-matched analysis. Dis Esophagus, 2020, 33(4): doz060.
9. 徐志华, 张含露, 杨梅, 等. 达芬奇机器人与胸腹腔镜联合辅助McKeown食管癌根治术后患者短期疼痛的非随机对照研究. 中国胸心血管外科临床杂志, 2018, 25(5): 378-381.
10. 刘继辉, 孙明, 余兵. 纵隔负压引流管在经右胸途径食管癌手术中的应用. 临床外科杂志, 2021, 29(8): 714-716.
11. 孙志勇, 曹子昂, 叶清, 等. 术前运用NRS2002评估食管癌患者营养风险及临床结局的研究. 中国胸心血管外科临床杂志, 2015, 22(4): 323-326.
12. 许淑华, 何祺煜, 王小军, 等. 胸腔镜食管癌术后常见并发症的比较分析. 东南大学学报 (医学版), 2021, 40(1): 74-77.
13. Sziklavari Z, Neu R, Hofmann HS, et al. Persistent pleural effusion following thoracic surgery. Chirurg, 2015, 86(5): 432-436.
14. Xu Y, Li XK, Cong ZZ, et al. Long-term outcomes of robotic-assisted versus thoraco-laparoscopic McKeown esophagectomy for esophageal cancer: A propensity score-matched study. Dis Esophagus, 2021, 34(9): doaa114.
15. Nakahara Y, Yamasaki M, Miyazaki Y, et al. Reflux after esophagectomy with gastric conduit reconstruction in the posterior mediastinum for esophageal cancer: Original questionnaire and EORTC QLQ-C30 survey. Dis Esophagus, 2018, 31(7): 1-7.
16. Quiding H, Häggquist SO. Visual analogue scale and the analysis of analgesic action. Eur J Clin Pharmacol, 1983, 24(4): 475-478.
17. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
18. 纪晨光, 刘丽, 冯志杰. 早期食管癌的内镜下诊治进展. 河北医科大学学报, 2021, 42(6): 735-739.
19. 侯广杰, 连戈, 郭宝峰, 等. 胸腹腔镜联合切除局部晚期食管癌手术视频要点. 中国胸心血管外科临床杂志, 2020, 27(6): 627-628.
20. Sihag S, Ku GY, Tan KS, et al. Safety and feasibility of esophagectomy following combined immunotherapy and chemoradiotherapy for esophageal cancer. J Thorac Cardiovasc Surg, 2021, 161(3): 836-843.
21. 徐杨, 申翼. 达芬奇机器人在食管外科中的应用. 医学研究生学报, 2021, 34(1): 1-7.
22. 范富翠, 童雅萍, 梁冠冕, 等. NRS2002结合营养指标评价食管癌术后出院患者的营养状况. 广东医学, 2020, 41(19): 1970-1974.
23. 赵澜涛, 王亮, 陈建海, 等. 经纵隔右胸腔引流管在食管癌根治术后引流效果分析. 山西医药杂志, 2020, 49(4): 447-449.
24. Marshall K, McLaughlin K. Pain management in thoracic surgery. Thorac Surg Clin, 2020, 30(3): 339-346.
25. Ashok A, Niyogi D, Ranganathan P, et al. The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection. Surg Today, 2020, 50(4): 323-334.
26. Rubinkiewicz M, Witowski J, Su M, et al. Enhanced recovery after surgery (ERAS) programs for esophagectomy. J Thorac Dis, 2019, 11(Suppl 5): S685-S691.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of drainage tube placed in left thoracic cavity versus placed in mediastinum after left pleura partial resection in robot-assisted McKeown esophagectomy for esophageal carcinoma

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