H. Ichikawa1, T. Otani1, T. Hanyu1, T. Ishikawa1, K. Usui1, M. Nemoto1, T. Sakai1, Y. Kano1, Y. Muneoka1, Y. Shimada1, M. Nagahashi1, J. Sakata1, T. Kobayashi1, H. Kameyama1, T. Wakai1 1Niigata University Graduate School of Medical and Dental Sciences,Division Of Digestive And General Surgery,Niigata, NIIGATA, Japan
Introduction: The impact of surgical procedures on respiratory functions after esophagectomy for esophageal cancer is not fully investigated. The aim of this study is to clarify the difference in short- and long-term respiratory functions after esophagectomy between the surgical procedures.
Methods: A total of 48 patients who underwent curative esophagectomy for thoracic esophageal cancer from 2003 to 2012 were enrolled in this single-institutional prospective study. We evaluated volume capacity (VC) and forced expiratory volume 1.0 (FEV1.0) at six points as follows: before esophagectomy (baseline), 3, 6, 12, 24 and 60 months after esophagectomy. We compared the change ratio to baseline values between the three surgical procedures: open esophagectomy (OE, N = 19), minimally invasive esophagectomy (MIE, N = 16), and transhiatal esophagectomy (THE, N = 13). The baseline respiratory functions before esophagectomy were not significantly different between the three groups.
Results: The decline of VC in THE group (median change ratio: 0.91) were significantly less than that in OE (0.75) and MIE group (0.80) 3 months after esophagectomy (P < 0.01). VC in MIE and THE group recovered at 0.94 and 0.98 of the median change ratios; however, VC in OE group remained at 0.85 and lower than that in MIE and THE group 12 months after esophagectomy (P = 0.016). The median change ratios of VC in OE (0.83), MIE (0.84) and THE groups (0.88) were not significantly different 60 months after esophagectomy (P = 0.176). FEV1.0 in OE (0.78) and MIE (0.81) group significantly more declined than that of THE group (0.97) after 3 months (P < 0.01). FEV1.0 in OE and MIE group recovered at 0.89 and 0.89; however, they were significantly lower than that in THE group (0.99) 12 months after esophagectomy (P = 0.015). Although FEV1.0 in THE group kept the baseline value after esophagectomy, the median change ratios of FEV1.0 in OE (0.84), MIE (0.86) and THE groups (0.94) were not significantly different 60 months after esophagectomy (P = 0.46).
Conclusion: THE contributes to maintaining short-term respiratory function after esophagectomy for esophageal cancer. MIE is advantageous in the early recovery of VC as compared with TTE. The differences in respiratory functions after esophagectomy between the surgical procedures are not observed after a long-term follow-up.