Comparative study of stress response,immune function and long-term effect of thoracic laparoscopy combined with right thoracic three-incision radical resection of esophageal cancer
HAN Dong
XUE Dongming
CHEN Xinyu
LI Yufeng
Abstract：Objective To compare the postoperative stress response,immune function,complications and longterm prognosis of middle thoracic esophageal cancer treated by transthoracic laparoscopy combined with radical resection of esophageal cancer and right thoracic three-incision approach.Methods A total of 100 patients with esophageal cancer who were treated in Xuzhou No.1 People's Hospital from March 2017 to March 2020 with focal locations in the middle chest segment were selected as study objects 50 patients who were treated by thoracic laparoscopy combined with radical resection of esophageal cancer were included in study group 1,and the other 50 patients who were treated by radical resection of esophageal cancer through right thoracic three-incision approach were classified into study group 2.The level of clinical indicators,the degree of postoperative stress reaction,the improvement of immune function,and the incidence of complications were compared between the two groups.Patients in both groups were followed up for one year to compare the long-term prognosis.Results The operative time,postoperative extubation time,anal exhaust time,defecation time,and hospital stay of study group 1 were all shorter than those of study group 2,and the intraoperative blood loss,postoperative drainage volume and postoperative pain scores were all lower than those of study group 2(P＜0.05).On the first day after operation,the serum Adrenaline(AD)and Cortisol(COR)levels in both groups were significantly higher than those before operation(P＜0.05).The levels of AD and COR in serum of both groups were significantly decreased 3 days after surgery compared with 1 day after surgery(P＜0.05).The levels of AD and COR in serum of study group 1 were lower than those of study group 2 at 1 day and 3 days after operation(P＜0.05).One week after operation,serum T lymphocyte surface antigen CD4(CD4+)and CD4+/serum T lymphocyte surface antigen CD8(CD8+)levels in both groups were higher than those before operation,and CD8+levels were lower than those before operation(P＜0.05).One week after operation,there was no statistical significance in serum CD4+,CD8+and CD4+/CD8+levels between study group 1 and study group 2(P＞0.05).The complication rate of study group 1 was 8.00%,which was lower than that of study group 2(26.00%)(P＜0.05).After 1 year follow-up,there was no significant difference in mortality between the two groups(P＞0.05).Conclusions In patients with esophageal cancer,the above two surgical methods can achieve the therapeutic purpose,improve the immune function,and achieve a good long-term prognosis.However,compared with the right thoracic three-incision approach radical surgery for esophageal cancer,transthoracic laparoscopic radical surgery for esophageal cancer has less stress reaction,shorter treatment time and recovery time,and lower complication rate.
Keywords：Thoracic laparoscopyRadical resection of esophageal carcinomaRight thoracic three-incision approachMiddle thoracic esophageal carcinomaStress responseImmune functionComplicationsLongterm prognosis
Publication Date：2024-08-20
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 361-365,371 )