Effect of azygos arch preservation during thoracoscopic esophagectomy on facilitation of postoperative refilling
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ORIGINAL ARTICLE
Effect of azygos arch preservation during thoracoscopic esophagectomy on facilitation of postoperative refilling Naoto Fujiwara 1 & Hiroshi Sato 1 & Yutaka Miyawaki 1 & Misato Ito 1 & Junya Aoyama 1 & Sunao Ito 1 & Shuichiro Oya 1 & Kenji Watanabe 1 & Hirofumi Sugita 1 & Shinichi Sakuramoto 1 Received: 26 June 2020 / Accepted: 22 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose In esophageal cancer surgery, the significance of preserving the azygos arch during thoracoscopic esophagectomy remains unknown. To determine the significance, we examined the difference in postoperative courses between patients who underwent an azygos arch-preserving technique and patients whose azygos arch had been dissected. Methods We retrospectively analyzed 119 patients with esophageal cancer who underwent thoracoscopic esophagectomy from January 2017 to December 2019. Statistical tests, including univariate or multivariate analyses and propensity score-matched analysis, were performed focusing on changes in fluid balance caused by the preservation of the azygos arch. Results The azygos arch was preserved in 65 patients and dissected in 54 patients. Urine output on postoperative day 2 was higher, and the IN-OUT balance on postoperative day 2 or accumulated IN-OUT balance up to postoperative day 2 tended to be lower in the azygos arch-preserving group than in the dissected group. The azygos arch-preserving technique did not affect the number of dissected mediastinal lymph nodes. Conclusion The azygos arch-preserving technique during thoracoscopic esophagectomy facilitated postoperative refilling and avoided postoperative fluid excess. This technique might be a novel minimally invasive option for an otherwise highly invasive esophageal cancer surgery. Keywords Minimally invasive surgery . Thoracoscopic esophagectomy . Azygos arch preservation . Facilitate postoperative refilling . Fluid balance
Introduction Esophageal cancer surgery involves invasive digestive surgery that causes frequent postoperative complications, especially cardiopulmonary dysfunction [1]. Minimally invasive surgery, including endoscopic surgery, is one attempt to reduce surgical invasiveness and postoperative complications. It has recently become popular in the field of digestive surgery and has also been introduced in esophageal cancer surgery [2]. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00423-020-01994-w) contains supplementary material, which is available to authorized users. * Naoto Fujiwara [email protected] 1
Department of Gastroenterological Surgery, Saitama Medical University, International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama 350-1298, Japan
The use of minimally invasive esophagectomy (MIE), including video-assisted thoracic surgery-esophagectomy (VATSE), is rapidly increasing, and several reports have demonstrated non-inferiority, reduced postoperative complications [3–7], or improvement of long-term postoperative quality
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