Application of total thoracoscopic ultrasonic scalpel resection in esophageal cancer patients

Abstract

BACKGROUND

Esophageal cancer is a prevalent solid malignancy of the gastrointestinal tract. Surgical resection remains an effective intervention for prolonging patient survival. While conventional open surgery demonstrates therapeutic efficacy, it is often associated with significant tissue trauma, high complication rates, and prolonged recovery period. Advances in imaging technology and refined minimally invasive techniques have led to an increasing adoption of total thoracoscopy-assisted resection among patients. However, the efficacy of total thoracoscopic ultrasonic scalpel resection specifically for esophageal cancer patients remains unclear.

AIM

To evaluate the efficacy of total thoracoscopic ultrasonic scalpel resection in esophageal cancer patients.

METHODS

We retrospectively analyzed clinical data from 127 esophageal cancer patients undergoing total thoracoscopy-assisted resection in our hospital from January 2022 to January 2025. Based on surgical technique, 61 patients subjected to total thoracoscopic electrosurgical scalpel esophagectomy were included in the control group, while 66 patients receiving total thoracoscopic ultrasonic scalpel esophagectomy were assigned to the observation group. Perioperative outcomes were compared between the two groups, including pain mediators [5-hydroxytryptamine (5-HT), potassium ions (K⁺), norepinephrine (NE)], immune indices (CD4⁺, CD8⁺, CD4⁺/CD8⁺), inflammatory markers [interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor alpha (TNF-α)], as well as pulmonary function parameters [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximal voluntary ventilation (MVV)]. Besides, complication rates were also assessed.

RESULTS

Operative time was significantly shorter in the observation group compared to the control group. The observation group demonstrated reduced intraoperative blood loss and lower postoperative chest drainage volume and increased number of dissected lymph nodes (P < 0.05 for all). Preoperatively, no significant differences were observed between the two groups in terms of 5-HT, K⁺, NE, CD4⁺, CD8⁺, CD4⁺/CD8⁺, IL-6, IL-8, TNF-α, FVC, FEV1, and MVV (P > 0.05). Postoperatively, both groups showed improvement in measured parameters, with the observation group exhibiting significantly better outcomes, that is, lower 5-HT, K⁺, and NE levels, higher CD4⁺ levels, lower CD8⁺ levels, and higher CD4⁺/CD8⁺ levels (P < 0.05); reduced IL-6, IL-8, and TNF-α (P < 0.05); superior FVC, FEV1, and MVV measurements (P < 0.05). The total complication rate was significantly lower in the observation group (7.58% vs 21.31%; P < 0.05).

CONCLUSION

Total thoracoscopic ultrasonic scalpel resection demonstrates superior surgical outcomes in esophageal cancer patients compared to electrosurgical techniques. This approach significantly improves perioperative indicators, ameliorates postoperative pain, enhances immune function, alleviates inflammatory responses, and preserves pulmonary function, demonstrating the safety and reliability of this technique in esophageal cancer patients.

Keywords: Esophageal cancer; Total thoracoscopy; Ultrasonic scalpel resection; Electrosurgical scalpel; Complication rate

Core Tip: Esophageal cancer remains a highly aggressive malignancy with significant implications for patient health. This retrospective cohort study demonstrates superior outcomes with total thoracoscopic ultrasonic scalpel resection vs electrosurgical resection. The ultrasonic scalpel significantly optimizes perioperative indicators, reduces postoperative pain, enhances immune function, suppresses inflammatory mediator release, preserves pulmonary function, while demonstrating a lower complication rate. These advantages support its broader clinical adoption for esophageal cancer resection.