Efficacy of Laparoscopic Minimally Invasive Radical Surgery for Esophageal Cancer via Different Approaches and Its Impact on Postoperative Residual Gastrointestinal Function and Nutritional Status
Objective:To investigate the efficacy of laparoscopic minimally invasive radical surgery for esophageal cancer via different approaches and its influence on postoperative residual gastrointestinal function and nutritional status.Methods:A total of 126 patients with esophageal cancer admitted to our hospital from May 2020 to May 2023 were selected and randomly divided into two groups:the transabdominal group and the thoracoabdominal group,with 63 cases in each group.The transabdominal group underwent laparoscopic mini-mally invasive radical surgery,while the thoracoabdominal group underwent thoracoabdominal combined lapa-roscopic minimally invasive radical surgery.The efficacy,perioperative conditions,trauma indicators[pre-and postoperative levels of C-reactive protein(CRP),interleukin-6(IL-6),interleukin-8(IL-8)],gas-trointestinal function indicators[postoperative gastric tube removal time,anal exhaust time,eating time,pre-and postoperative levels of vasoactive intestinal peptide(VIP),somatostatin(SS),motilin(MTL)],nutri-tional status[pre-and postoperative serum albumin(ALB),prognostic nutritional index(PNI),subjective global assessment(SGA)score],and postoperative complications were compared between the two groups.Results:The comparison of positive margin rate,surgical cure rate between the two groups showed no statisti-cal significance(P>0.05);the thoracoabdominal group had shorter operative time(131.52±18.77)min,postoperative anal exhaust time(2.52±0.60)d,postoperative nasogastric tube removal time(2.88±0.47)d,postoperative oral intake time(4.38±0.85)d,postoperative ambulation time(5.82±1.16)d,and hospi-tal stay(10.72±2.01)d,all shorter than those of the abdominal group[(155.94±21.67)min,(3.40±0.66)d,(3.34±0.53)d,(5.62±0.92)d,(7.10±1.24)d,(12.39±2.33)d,respectively],intraopera-tive blood loss,and postoperative drainage volume were(112.46±14.21)mL and(160.89±22.37)mL,re-spectively,both lower than those of the abdominal group[(124.31±16.08)mL,(186.27±20.15)mL,re-spectively],the number of lymph nodes dissected was(15.27±1.76),higher than that of the abdominal group(13.15±1.63)(t=6.761,7.831,5.154,7.858,5.983,4.308,4.383,6.691,7.015,all P<0.001);on postoperative days 1 and 3,serum CRP levels of the thoracoabdominal group were(72.36±16.20)mg/L and(35.28±10.08)mg/L,respectively,lower than those of the abdominal group[(96.58±14.77)mg/L and(51.17±11.62)mg/L,respectively],IL-6 levels were(212.34±33.16)ng/L and(142.32±23.57)ng/L,respectively,lower than those of the abdominal group[(254.39±37.49)ng/L and(180.67±27.13)ng/L,respectively],IL-8 levels were(0.28±0.09)μg/L and(0.14±0.04)μg/L,respectively,lower than those of the abdominal group[(0.42±0.11)μg/L and(0.25±0.07)μg/L,respectively],VIP levels were(28.76±4.05)pg/mL and(34.69±4.28)pg/mL,respectively,higher than those of the abdom-inal group[(25.14±3.63)pg/mL and(30.52±3.91)pg/mL,respectively],SS levels were(18.23±3.10)pg/mL and(20.21±2.36)pg/mL,respectively,higher than those of the abdominal group[(16.17±2.86)pg/mL and(18.08±2.44)pg/mL,respectively],MTL levels were(242.16±21.18)pg/mL and(257.90±23.25)pg/mL,respectively,higher than those of the abdominal group[(227.43±20.64)pg/mL and(238.41±21.76)pg/mL,respectively](t=8.769,8.199,6.668,8.470,7.818,10.829,5.283,5.709,3.877,4.980,3.953,4.858,all P<0.001);1 month postoperatively,serum ALB and the differ-ence values of the thoracoabdominal group were(75.61±8.03)g/L and(11.95±6.51)g/L,respectively,higher than those of the abdominal group[(70.58±5.95)g/L and(70.58±5.95)g/L,respectively],PNI and the difference values were(62.48±6.17)and(14.22±5.13)g,respectively,higher than those of the abdominal group[(57.13±5.82)and(8.60±5.22),respectively],SGA scores and the difference values were(9.08±1.42)points and(5.49±1.58)points,respectively,higher than those of the abdominal group[(11.15±1.76)points and(3.06±1.49)points,respectively](t=3.944,4.8470,5.007,6.095,7.265,8.881,all P<0.001);the incidence of complications in the thoracoabdominal group was 6.35%,lower than that in the abdominal group of 19.05%(χ2=4.582,P=0.032).Conclusion:Thoracoabdominal com-bined laparoscopic minimally invasive radical surgery for esophageal cancer is effective,can optimize the surgi-cal pathway,reduce tissue trauma,help restore gastrointestinal function,improve patient nutritional status,reduce the incidence of complications,and accelerate postoperative recovery.
Esophageal cancerAbdominal cavity pathwayThoracoabdominal combined path-wayRadical resection of esophageal cancerGastrointestinal function
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