Mediastinoscopy-assisted esophagectomy for esophageal cancer in patients with serious comorbidities.

Koide, Naohiko; Takeuchi, Daisuke; Suzuki, Akira; Miyagawa, Shinichi

PURPOSE We evaluated the results of mediastinoscopy-assisted esophagectomy (MAE), performed for esophageal cancer patients with comorbidities, versus those of thoracoscopic esophagectomy (TSE), performed for esophageal patients with or without comorbidities. METHODS Among 153 patients who underwent esophageal cancer surgery at our hospital, 17 (11.1%) underwent MAE and 37 (24.2%) underwent TSE. RESULTS Many of the MAE group patients had pulmonary (P < 0.001), cardiovascular (P = 0.031), or hepatic (P = 0.0029) diseases preoperatively, and these comorbidities frequently overlapped (P < 0.0001). The %VC and FEV(1)/FVC were lower (P = 0.0099 and P = 0.0057, respectively), and the ICG-R15 and serum level of HbA1c were higher (P = 0.0014 and P = 0.043, respectively) in the MAE group. There were no differences in postoperative complications or in the modified Clavien classification between the groups. There was no mortality in either group. After MAE, 5 (29.4%) patients died of other diseases. The 5-year overall survival rate after MAE was poorer than that after TSE (56.1 vs. 71.8%), but the 5-year cause-specific survival rates were similar in the two groups. CONCLUSIONS MAE is feasible for esophageal cancer patients with serious comorbidities and may decrease morbidity and mortality.