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

Table 1 Patient demographics n (%)

	3D-VATEn = 45	2D-VATEn = 48	P value
Age (yr)	63.8 ± 10.2	65.1 ± 9.8	0.55
Gender			0.66
Male	29 (64.4)	34 (70.8)
Female	16 (35.6)	14 (29.2)
Functional status			0.25
Independence	44 (97.8)	47 (97.9)
Partial dependence	1 (2.2)	0 (0)
Complete dependence	0 (0)	1 (2.1)
Weight loss1	13 (28.9)	11 (22.9)	0.64
Smoking2	7 (15.6)	9 (18.8)	0.91
Use of AAS	0 (0)	1 (2.1)	1
LEVF%	68.7 ± 1.5	68.6 ± 1.5	0.73
FS%	39.3 ± 2.3	39.5 ± 2.0	0.7
Hypertension	10 (22.2)	19 (39.6)	0.078
Renal failure	0 (0)	2 (4.2)	0.5
Dialysis	0 (0)	1 (2.1)	1
Ascites	1 (2.2)	1 (2.1)	0.96
Esophageal varices	0 (0)	1 (2.1)	1
Preoperative chemotherapy	8 (17.8)	9 (18.8)	1
Preoperative radiation	12 (26.7)	13 (27.1)	1
Prior operation	0 (0)	1 (2.1)	1

¹Weight loss > 10% over 6 mo;

²Smoking over the past year. Prior operation within 30 d. AAS: Anabolic-androgenic steroids; LEVF: Left ventricular ejection fraction; FS: Fraction shortening; VATE: Video-assisted thoracoscopic esophagectomy; 3D: Three-dimensional; 2D: Two-dimensional.

Table 2 Postoperative morbidity and mortality n (%)

	3D-VATE(n = 45)	3D-VATE(n = 48)	P value
Morbidity	13 (28.9)	8 (16.7)	0.328
Mortality	1 (2.2)	1 (2.1)	NS
Pulmonary complications			NS
Pneumonia	5 (11.1)	7 (14.6)	0.76
Re-intubation	4 (8.9)	5 (10.4)
Pulmonary embolism	1 (2.2)	1 (2.1)
Ventilation > 48 h	4 (8.9)	4 (8.3)
Wound infections			NS
Neck	0 (0)	0 (0)
Thorax	0 (0)	1 (2.1)
Abdomen	0 (0)	0 (0)
Renal complications			NS
Progressive renal insufficiency	0 (0)	0 (0)
Acute renal failure	0 (0)	0 (0)
Urinary tract infections	1 (2.2)	1 (2.1)
Cardiac complications			NS
Cardiac arrest	0 (0)	0 (0)
Myocardial infarction	0 (0)	0 (0)
Tachycardia/arrhythmias	1 (2.2)	4 (8.3)	0.363
Deep venous thrombosis	0 (0)	0 (0)	NS
Anastomotic leakage	1 (2.2)	1 (2.1)	NS
Unplanned return to OR	2 (4.4)	4 (8.3)	0.678

NS: Not significant; OR: Operating room; 3D-VATE: Three-dimensional video-assisted thoracoscopic esophagectomy.

Table 3 Surgical recovery indicators

	3D-VATE (%)n = 45	2D-VATE (%)n = 48	P value
Thoracoscopic operating time1 (min)	68 ± 13.79	83 ± 13	< 0.01
Operating time2 (min)	138 ± 14	167 ± 20	< 0.01
Bleeding (mL)	68.2 ± 10.7	89.8 ± 10.4	< 0.01
Chest drains (mL)	306.6 ± 56.2	366.4 ± 62.6	< 0.01
Chest tube duration (d)	2.67 ± 1.01	3.75 ± 1.15	< 0.01
Length of stay (d)	9.07 ± 2.00	10.85 ± 3.40	0.003
Expenses (RMB)	74968.4 ± 9637.8	86211.1 ± 8519.7	< 0.01

¹Thoracoscopic operating time refers to the resection time;

²Operating time is the time from skin incision to the final skin closure. VATE: Video-assisted thoracoscopic esophagectomy; 3D: Three-dimensional; 2D: Two-dimensional.

Table 4 Preoperative baselines of pulmonary function

	3D-VATE (%)(n = 45)	2D-VATE (%)(n = 48)	P value
Smoking1	7 (15.6)	9 (18.8)	0.91
FEV1 (L)	2.73 ± 0.36	2.77 ± 0.36	0.65
FEV1%	85.1 ± 5.8	86.6 ± 6.5	0.26
Dlco%	91.9 ± 3.88	92.8 ± 3.78	0.23
PaO2 (mmHg)	407.8 ± 19.7	402.1 ± 18.7	0.16
BMI	22.5 ± 2.0	22.2 ± 2.0	0.44
ASA class	2.58 ± 0.54	2.58 ± 0.53	0.96

¹Smoking (in the past year). FEV₁: Forced expiratory volume in one second; Dlco: Diffusing capacity of the lung for carbon monoxide; PaO₂: Oxygen tension; BMI: Body mass index; ASA class: American Society of Anesthesiologists physical status classification system; 3D: Three-dimensional; 2D: Two-dimensional.

Table 5 Inflammatory markers

	3D-VATEn = 45	2D-VATEn = 48	P value
Preoperative baselines
WBC (109/L)	5.54 ± 0.88	5.39 ± 0.89	0.45
GR (109/L)	3.88 ± 0.55	3.77 ± 0.52	0.28
hsCRP (mg/L)	1.76 ± 0.43	1.82 ± 0.43	0.51
PCT (μg/L)	0.03 ± 0.01	0.03 ± 0.01	0.97
Postoperative outcomes
ΔWBC
POD1 (109/L)	5.64 ± 1.60	6.75 ± 1.37	0.001
POD4 (109/L)	3.87 ± 1.05	6.65 ± 1.01	< 0.01
POD7 (109/L)	2.48 ± 0.50	2.54 ± 0.66	0.667
ΔGR
POD1 (109/L)	4.88 ± 1.18	6.13 ± 1.42	< 0.01
POD4 (109/L)	3.59 ± 0.85	6.25 ± 1.21	< 0.01
POD7 (109/L)	2.24 ± 0.63	2.68 ± 0.67	0.001
ΔCRP
POD1 (mg/L)	42.5 ± 15.3	40.1 ± 16.9	0.544
POD4 (mg/L)	102.5 ± 61.3	137.9 ± 64.1	< 0.01
POD7 (mg/L)	88.4 ± 47.1	91.5 ± 41.3	0.225
ΔPCT
POD1 (μg/L)	0.71 ± 0.17	0.68 ± 0.20	0.414
POD4 (μg/L)	0.32 ± 0.14	0.71 ± 0.14	< 0.01
POD7 (μg/L)	0.46 ± 0.23	1.01 ± 0.26	< 0.01

WBCs: White blood cells; GR: Granulocytes; hsCRP: Hypersensitive C-reactive protein; PCT: Procalcitonin; Δ: Data compared to baselines; VATE: Video-assisted thoracoscopic esophagectomy; 3D: Three-dimensional; 2D: Two-dimensional.

Table 6 Histopathological results and lymph node dissection/exposure n (%)

	3D-VATEn = 45	2D-VATEn = 48	P value
Tumor location			NS
Upper third of the esophagus	8 (17.8)	9 (18.8)
Middle third of the esophagus	29 (64.4)	30 (62.5)
Lower third of the esophagus	8 (17.8)	9 (18.8)
Histological type			NS
Adenocarcinoma	0 (0)	1 (2.1)
Squamous cell carcinoma	45 (100)	47 (97.9)
TNM stage			NS
I	12 (26.7)	9 (18.8)
II	16 (35.5)	13 (27.1)
III	17 (37.8)	26 (54.2)
Lymph nodes dissection
Total1 LNN	24.8 ± 5.2	21.4 ± 6.3	NS
Thoracic LNN	13.13 ± 3.43	8.96 ± 4.05	< 0.01
Thoracic LN group	2.56 ± 1.12	2.00 ± 0.85	0.008
Laryngeal recurrent nerve LNN (L)	2.67 ± 1.15	1.17 ± 0.83	< 0.01
Laryngeal recurrent nerve LNN (R)	2.27 ± 1.74	2.33 ± 1.39	NS
Esophageal LNN	3.64 ± 2.05	3.58 ± 1.16	NS
Subcarinal LNN	3.89 ± 2.59	2.73 ± 1.08	0.005
Lymph nodes exposure
Recurrent laryngeal nerve (L) (Y)	41 (91.1)	35 (72.9)	0.031
Recurrent laryngeal nerve (R) (Y)	43 (95.6)	43 (89.6)	0.44

¹Inclusive for lymph nodes harvested from the abdomen, chest and neck. TNM: Tumor node metastasis; LNN: Lymph node number; L: Left; R: Right; NS: Not significant; VATE: Video-assisted thoracoscopic esophagectomy; 3D: Three-dimensional; 2D: Two-dimensional.