Pros and cons of the gasless laparoscopic transhiatal esophagectomy for upper XXXX .

@entity1 @entity834 @entity190 @entity260 @entity18274 @entity358 @entity86 @entity418
BACKGROUND: Controversies on how to treat upper @entity418 have existed for several decades. With the application of minimally invasive techniques, surgical treatment to upper @entity418 tends to show more advantages and attract more @entity1 . Up to now, most hospitals adopted the @entity18274 ( @entity18274 ) as the way of minimally invasive surgery for upper @entity418 . But @entity18274 to treat upper @entity418 has its drawbacks, such as demanding certain pulmonary function and severe @entity86 . In 2011, we developed the gasless laparoscopic transhiatal esophagectomy (LTE) to treat upper @entity418 , which showed some advantages. The aim of this article was to compare LTE with @entity18274 in treating @entity418 and assess the value of LTE. METHODS: From 2009 to 2014, esophagectomy has been performed by the introduction of minimally invasive surgery in a total of 83 @entity1 with @entity418 . Among these @entity1 , LTE was performed in 27 cases (Group 1), while @entity18274 was performed in the other 56 (Group 2). Neoadjuvant chemotherapy was done in @entity1 of Group 1. RESULTS: There were no operation-related deaths and conversion to open procedure. There was no significant difference in postoperative complications, ventilation time, ICU stay, hospital stay, and @entity834 rates between the two groups. But LTE was associated with shorter operative time and less intraoperative @entity190 . In Group 2, 21 (37.5  %) @entity1 had @entity260 , while in Group 1, there were 6 (22.2  %) @entity1 having @entity358 at least one time. Results of 24-h pH monitoring and manometry showed that postoperative laryngo-pharyngeal reflux (PLPR) was more severe in Group 2 @entity1 than in Group 1; for Group 1, PLPR mainly occurred on sleep stage, while for Group 2, PLPR might exist all the day with short intervals and last longer at night. The median overall survival was 27.2  months after @entity18274 and 30.8  months after LTE (P  =  0.962). There was no significant difference in survival at 2, 3 and 4  years between the two groups. CONCLUSIONS: Compared with @entity18274 , LTE is a more minimally invasive approach to effectively treat @entity1 with upper @entity418 . Laryngo-pharyngeal reflux after LTE was less severe than that after @entity18274 , which might lower incidence of @entity358 . For the elderly @entity1 , LTE seems more suitable.
