Thoracoscopic vs open esophagectomy: Short-term efficacy with laparoscopic gastric tube

doi:10.4240/wjgs.v18.i5.116490

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Publication Name

World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. May 27, 2026; 18(5): 116490
Published online May 27, 2026. doi: 10.4240/wjgs.v18.i5.116490

Thoracoscopic vs open esophagectomy: Short-term efficacy with laparoscopic gastric tube

Yong-Sheng Meng, Xiao-Wei Zhang, Jin-Long Kang, Jun-Jun Zhou

Yong-Sheng Meng, Xiao-Wei Zhang, Jun-Jun Zhou, Department of Thoracic Surgery, The Ninth Medical Center of Chinese PLA General Hospital, Beijing 100101, China

Jin-Long Kang, Department of Thoracic Anesthesiology, The Ninth Medical Center of Chinese PLA General Hospital, Beijing 100101, China

Co-first authors: Yong-Sheng Meng and Xiao-Wei Zhang.

Author contributions: Meng YS, Zhang XW, and Zhou JJ contributed to conceptualization and design; Meng YS and Zhang XW contributed to data collection, experimental operations, data analysis and interpretation, initial paper writing, and paper revision as co-first authors; Kang JL and Zhou JJ contributed to review; Kang JL provides technical support, data organization and visualization; Zhou JJ contributed to funding acquisition, project management and supervision, and critical revision; all authors approved the final version.

Institutional review board statement: The study was approved by Research Ethics Committee of the Ninth Medical Center of Chinese PLA General Hospital, No. 2023(LD-018).

Informed consent statement: All study participants and their legal guardians provided written informed consent before recruitment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: No additional data are available.

Corresponding author: Jun-Jun Zhou, Research Fellow, Department of Thoracic Surgery, The Ninth Medical Center of Chinese PLA General Hospital, No. 9 Anxiang Beili, Chaoyang District, Beijing 100101, China. jun9zx@163.com

Received: December 12, 2025
Revised: January 18, 2026
Accepted: February 25, 2026
Published online: May 27, 2026
Processing time: 166 Days and 5 Hours

Abstract

BACKGROUND

Esophagectomy remains the cornerstone of curative treatment for resectable esophageal cancer (EC). Traditional open surgery is associated with significant surgical trauma, slow postoperative recovery, and high complication rates. With rapid advancements in minimally invasive techniques, video-assisted thoracoscopic surgery combined with laparoscopic gastric mobilization has been increasingly adopted for tubular stomach creation. The short-term efficacy and recovery advantages of this minimally invasive approach compared to conventional open esophagectomy remain debatable.

AIM

To compare the short-term outcomes of thoracoscopic and open esophagectomy approaches in patients with EC.

METHODS

A retrospective analysis was conducted on patients who underwent radical esophagectomy for EC. Patients were divided into a thoracoscopic group (laparoscopic gastric mobilization with tubular stomach reconstruction + thoracoscopic esophagectomy + cervical anastomosis, n = 58) and an open surgery group (laparoscopic gastric mobilization with tubular stomach reconstruction + open esophagectomy + cervical anastomosis, n = 40). Perioperative variables, postoperative recovery parameters, pain scores, inflammatory and stress responses, postoperative complications, and quality of life were compared between the two groups.

RESULTS

Intraoperative blood loss, chest drainage duration, time to first ambulation, postoperative hospital stay, bowel sound recovery, and time to liquid diet tolerance were all significantly lower in the thoracoscopic group vs open surgery. The thoracoscopic group had a lower total complication rate in the (24.1% vs 47.5%; P < 0.05). One month postoperatively, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 scores for overall health status, physical functioning, and role functioning were significantly higher after thoracoscopic surgery. Postoperative pain scores and C-reactive protein and interleukin-6 levels were significantly lower in the thoracoscopic group at all time-points compared with the open surgery group.

CONCLUSION

Thoracoscopic esophagectomy combined with laparoscopic gastric mobilization and tubular stomach reconstruction offers significant advantages, contributes to an improved postoperative quality of life and should be further promoted in clinical practice.

Keywords: Esophageal neoplasms; Thoracoscopic surgery; Open surgery; Laparoscopy; Short-term efficacy

Core Tip: This retrospective study demonstrated that minimally invasive thoracoscopic esophagectomy, when combined with laparoscopic gastric mobilization, provides superior short-term outcomes compared to conventional open surgery for esophageal cancer. It minimizes surgical trauma and accelerates recovery, reduces postoperative pain, systemic inflammation, and stress response, and ultimately enhancing patients’ early postoperative quality of life. These findings support broader clinical adoption of this minimally invasive surgical approach.