Materials and methods
Study design and patient selection
Operative methods
Definitions
Statistical methods
Results
Patient characteristics and operative details
Open (n = 109) | Thoracoscopy (n = 101) |
P
a
| |||
---|---|---|---|---|---|
n
| % |
n
| % | ||
Age (years) | |||||
Median (range) | 62 (41–75) | 63 (48–75) | 0.522b
| ||
Gender | |||||
Male | 93 | 85.3 | 82 | 81.2 | 0.462 |
Female | 16 | 14.7 | 19 | 18.8 | |
Body mass index | |||||
Median (range) | 22 (13–29) | 23 (17–28) | 0.934b
| ||
Tumor location | |||||
Upper thoracic | 12 | 11.0 | 15 | 14.9 | 0.183 |
Mid-thoracic | 65 | 59.6 | 67 | 66.3 | |
Lower thoracic | 32 | 29.4 | 19 | 18.8 | |
Tumor size | |||||
≤4 cm | 76 | 69.7 | 70 | 69.3 | 1.000 |
>4 cm | 33 | 30.3 | 31 | 30.7 | |
Lymphadenectomy | |||||
Two-field | 41 | 37.6 | 40 | 39.6 | 0.779 |
Three-field | 68 | 62.4 | 61 | 60.4 | |
Abdominal approach | |||||
Open | 102 | 93.6 | 43 | 42.6 | <0.0001 |
Laparoscopy | 7 | 6.4 | 58 | 57.4 | |
Reconstruction route | |||||
Ante-sternal | 6 | 5.5 | 0 | 0 | <0.0001 |
Retrosternal | 50 | 45.9 | 23 | 22.8 | |
Posterior mediastinal | 53 | 48.6 | 78 | 77.2 | |
Blood loss (mL) | |||||
Median (range) | 412 (45–1,833) | 293 (0–4,225) | <0.001b
| ||
Operating time (min) | |||||
Median (range) | 399 (222–638) | 510 (310–871) | <0.0001b
| ||
Red blood cell transfusion | |||||
Yes | 5 | 4.5 | 3 | 3.0 | 0.723 |
Lymph nodes harvested | |||||
Median (range) | 47 (19–120) | 56 (18–120) | 0.063b
|
Perioperative morbidity and mortality
Open (n = 109) | Thoracoscopy (n = 101) |
P
a
| |||
---|---|---|---|---|---|
n
| % |
n
| % | ||
Intraoperative complications | 3 | 2.8 | 3 | 3.0 | 1.000 |
Postoperative complications (any) | 48 | 44.0 | 45 | 44.6 | 1.000 |
Pulmonary | |||||
Atelectasis | 24 | 22.0 | 11 | 10.9 | 0.041 |
Pneumonia | 17 | 15.6 | 8 | 7.9 | 0.093 |
Recurrent nerve palsy | 17 | 15.6 | 15 | 14.9 | 1.000 |
Anastomotic leak | 15 | 13.8 | 7 | 6.9 | 0.120 |
Intravascular catheter infection | 4 | 3.7 | 2 | 2.0 | 0.684 |
Paralytic ileus | 2 | 1.8 | 3 | 3.0 | 0.673 |
Intestinal obstruction | 0 | 0 | 4 | 4.0 | 0.052 |
Other | 5 | 4.6 | 16 | 15.8 | 0.010 |
Reoperation | 2 | 1.8 | 10 | 9.9 | 0.016 |
Postoperative mortality | 1 | 0.9 | 1 | 1.0 | 1.000 |
Postoperative length of stay (days) | |||||
Median (range) | 22 (10–162) | 24 (9–185) | 0.472b
|
Total (n = 210) | Any complication (n = 93) | Reoperation (n = 12) | |||||
---|---|---|---|---|---|---|---|
n
|
n
| % |
P
a
|
n
| % |
P
a
| |
Age | 0.78 | 0.54 | |||||
<65 | 129 | 56 | 43.4 | 6 | 4.7 | ||
≥65 | 81 | 37 | 45.7 | 6 | 7.4 | ||
Gender | 1.00 | 1.00 | |||||
Male | 175 | 78 | 44.6 | 10 | 5.7 | ||
Female | 35 | 15 | 42.9 | 2 | 5.7 | ||
Body mass index | 0.73 | 0.71 | |||||
<25 | 168 | 73 | 43.5 | 9 | 5.4 | ||
≥25 | 42 | 20 | 47.6 | 3 | 7.1 | ||
Tumor location | 0.43 | 0.093 | |||||
Upper thoracic | 27 | 14 | 51.9 | 4 | 14.8 | ||
Mid-thoracic | 132 | 60 | 45.5 | 5 | 3.8 | ||
Lower thoracic | 51 | 19 | 37.3 | 3 | 5.9 | ||
Tumor size | 0.29 | 0.11 | |||||
≤4 cm | 146 | 61 | 41.8 | 11 | 7.5 | ||
>4 cm | 64 | 32 | 50.0 | 1 | 1.6 | ||
Lymphadenectomy | 0.20 | 0.54 | |||||
Two-field | 81 | 31 | 38.3 | 6 | 7.4 | ||
Three-field | 129 | 62 | 48.1 | 6 | 4.7 | ||
Thoracic approach | 1.00 | 0.016 | |||||
Open | 109 | 48 | 44.0 | 2 | 1.8 | ||
Thoracoscopy | 101 | 45 | 44.6 | 10 | 9.9 | ||
Abdominal approach | 0.88 | 0.20 | |||||
Open | 145 | 65 | 44.8 | 6 | 4.1 | ||
Laparoscopy | 65 | 28 | 43.1 | 6 | 9.2 |
Reoperation
Abdominal approach | Thoracic approach | |
---|---|---|
Open (n = 2) | Thoracoscopy (n = 10) | |
Open (n = 6) | Gastric conduit ischemia | Mediastinal abscess not related to leak |
Thoracic bleeding | Chylous leak from thoracic duct | |
Mechanical obstruction of jejunum | ||
Pancreatic juice leak | ||
Laparoscopy (n = 6) | Air leak from a bulla on the right lung | |
Cervical abscess related to leak | ||
Gastric conduit ischemia | ||
Transhiatal herniation of colon | ||
Acute cholecystitis | ||
Omental necrosis |
Laboratory abnormalities
Grade 3 or 4 Abnormalities | Open (n = 109) | Thoracoscopy (n = 101) |
P
a
| ||
---|---|---|---|---|---|
n
| % |
n
| % | ||
Decreased white blood cell count | 0 | 0 | 0 | 0 | N/A |
Decreased hemoglobin | 11 | 10.1 | 5 | 5.0 | 0.20 |
Decreased platelet count | 1 | 0.9 | 0 | 0 | 1.00 |
Increased blood bilirubin | 9 | 8.3 | 10 | 9.9 | 0.81 |
Increased AST | 10 | 9.2 | 10 | 9.9 | 1.00 |
Increased ALT | 28 | 25.7 | 17 | 16.8 | 0.13 |
Increased Creatinine | 2 | 1.8 | 0 | 0 | 0.50 |