Combination of video-assisted thoracoscopic surgery and hand-assisted laparoscopic surgery for early cancer of the thoracic esophagus.
From June 1997 to July 2002, we enrolled 10 patients with T1 esophageal squamous cell carcinoma according to the findings of chest computerized tomography scans and transesophageal ultrasound. There were nine men and one woman. The average age was 57.1 years (range, 43-70 years). We performed a combination of video-assisted thoracoscopic surgery including endoscopic esophageal mobilization and mediastinal lymph nodes dissection for early thoracic esophageal carcinoma as well as hand-assisted laparoscopic gastric mobilization as an esophageal substitute under double-lumen intubated anesthesia. The average operative time was 330 minutes (range, 290-425 minutes). The average hospital stay was 11.2 days (range, 9-17 days). There was no surgical mortality or severe complication except one mild leakage of cervical esophagogastrostomy. All patients have tolerated solid food well and are still alive, without evidence of tumor recurrence, after a mean of 37.2 months of follow-up (range, 9-62 months). In conclusion, we suggest that a combination of video-assisted thoracoscopic esophageal mobilization and mediastinal lymph nodes dissection and hand-assisted laparoscopic mobilization of stomach via a hand-port device for esophageal reconstruction is a safe and feasible operation for patients with T1 thoracic esophageal carcinoma.