Exclusive right thoracic approach for esophagus surgery

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Geriatric Medicine

Background:

• The exclusive right thoracic approach for esophageal surgery is infrequently reported, particularly in China.
• Elderly patients often present with diminished pulmonary function, posing surgical challenges.

Purpose of the Study:

• To evaluate the feasibility and outcomes of an exclusive right thoracic approach for esophageal cancer resection in elderly patients with poor pulmonary function.
• To determine the safety and efficacy of this surgical technique in a specific patient cohort.

Main Methods:

• Retrospective review of 21 elderly esophageal cancer patients (average age 76.6) with low pulmonary function undergoing exclusive right thoracic surgery (January 2010 - January 2015).
• Detailed preoperative assessment including multidisciplinary team discussion and cardiopulmonary reserve evaluation.
• Standardized surgical technique involving right thoracic dissection, stomach mobilization, and stapled anastomosis in the thoracic cavity.

Main Results:

• All 21 operations were successfully completed using the exclusive right thoracic approach.
• Two early postoperative deaths occurred due to pulmonary infection and pulmonary artery embolism.
• The one-year postoperative survival rate was 66.7% in this high-risk group.

Conclusions:

• The exclusive right thoracic approach can be selectively employed for elderly patients with esophageal cancer and compromised pulmonary function.
• Careful patient selection, thorough preoperative preparation, and multidisciplinary assessment are essential for successful outcomes.
• This approach offers a potential surgical option for select frail elderly patients requiring esophageal resection.