Three-dimensional vs two-dimensional video assisted thoracoscopic esophagectomy for patients with esophageal cancer

AIM: To define the benefits of three-dimensional video-assisted thoracoscopic esophagectomy(3D-VATE)over 2D-VATE for esophageal cancer.METHODS: A total of 93 patients with esophageal cancer including 45 patients receiving 3D-VATE and48 receiving 2D-VATE were evaluated. Data related to patient and cancer characteristics, operating time,intraoperative bleeding, morbidity and mortality,postoperative inflammatory markers, Numerical Rating Scale for postoperative pain, Constant-Murley rating system for shoulder recovery and oxygenation index(OI) were collected. All medical records were retrieved from a prospectively maintained oncological database at our institution. A retrospective study was performed to compare the short-term surgical outcomes between the two groups.RESULTS: No significant differences were found between the two groups in either morbidity or mortality(P = 0.328). An enhanced surgical recovery was noted in the 3D group as indicated by shortened thoracoscopic operation time(3D vs 2D: 68 ± 13.79 min vs 83 ± 13min, P < 0.01), minor intraoperative blood loss(3D vs 2D: 68.2 ± 10.7 ml vs 89.8 ± 10.4 ml, P < 0.01),earlier chest tube removal(3D vs 2D: 2.67 ± 1.01 vs3.75 ± 1.15 d, P < 0.01), shorter length of hospital stay(3D vs 2D: 9.07 ± 2.00 vs 10.85 ± 3.40 d, P <0.01), lower in-hospital expenses(3D vs 2D: 74968.4± 9637.8 vs 86211.1 ± 8519.7 RMB, P < 0.01), lower pain intensity(P < 0.01) and faster recovery of the left shoulder function(P < 0.01). Better preservation of the pulmonary function was also found in the 3D group as the decline of the OI post operation was significantly lower than that of the 2D group(P < 0.01). Changes of postoperative inflammatory markers, including procalcitonin [postoperative days(PODs) 4 and 7: P <0.01], peripheral granulocytes(PODs 1, 4 and 7: P <0.01) and hypersensitive C-reactive protein(POD 4: P< 0.01) in 3D-VATE patients were less than those in the 2D group. Moreover, utilization of the 3D technique extended the dissection of the thoracic lymph nodes(P < 0.01), with better exposure of nodes in the left recurrent laryngeal nerve(P = 0.031).CONCLUSION: 3D-VATE could be a more viable technique over 2D-VATE in terms of short-term outcomes for patients with esophageal cancer.