The impact of combined thoracoscopic and laparoscopic surgery on pulmonary complications after radical esophagectomy in patients with resectable esophageal cancer

Pulmonary complications (PCs) after esophagectomy for patients with esophageal cancer have been correlated with prolonged hospital stays and in-hospital mortality. Previous studies have shown that minimally-invasive esophagectomy (MIE) is associated with a lower rate of PCs compared to conventional open surgery. Although PCs were reportedly associated with many factors, including surgical approaches, patients' demographics, and perioperative variables, the predictive factors for PCs including MIE, have not been fully evaluated. A total of 209 patients with resectable esophageal cancer who underwent three types of esophagectomy were included in the present study; (i) 93 cases who underwent the combined thoracoscopic MIE and laparoscopic MIE; (ii) 42 cases who underwent the combined open thoracotomy and laparoscopic MIE; (iii) 74 cases who underwent the combined open thoracotomy and open laparotomy, which were defined as the total MIE group, hybrid MIE group, and total open group, respectively. We compared clinical outcomes of the three groups and identified postoperative predictive factors of PCs using multivariate analysis. The incidence of PCs was significantly reduced (p=0.015) in the total-MIE group (8/93: 8.5%) compared with the total-open group (16/74: 21.6%), but it was not significantly reduced in the hybrid MIE group (5/42: 11.9%) compared with the total open group (p=0.19). The multivariate analysis showed that the presence of cardiac comorbidity [odds ratio (OR)=5.90; p=0.013], lung comorbidity (OR=3.95; p=0.031), and anastomotic leakage (OR=6.00; p