Nursing outcome comparison of laparoscopy-assisted, pneumomediastinoscopy-assisted esophagectomy vs conventional thoracoscopic-assisted, three-incision esophagectomy in early esophageal cancer

Table 1 Baseline characteristics and preoperative risk profile, n (%)/mean ± SD

Variable	Control group	Observation group	Test	P value
Age (years)	61.17 ± 9.40	62.68 ± 8.14	Welch t	0.368
BMI (kg/m2)	22.77 ± 2.77	23.35 ± 2.76	Welch t	0.273
FEV1 (L)	2 ± 0.44	1.93 ± 0.40	Welch t	0.432
FEV1/FVC (%)	67.03 ± 7.68	68.92 ± 9.18	Welch t	0.250
Albumin (g/L)	38.44 ± 3.41	39.11 ± 3.37	Welch t	0.305
Hemoglobin (g/L)	120.82 ± 13.39	124.58 ± 12.40	Welch t	0.129
Gender			χ2 test	0.533
Female	15 (25)	10 (20)
Male	45 (75)	40 (80)
Smoking history			χ2 test	0.330
No	28 (46.70)	28 (56)
Yes	32 (53.30)	22 (44)
COPD or other chronic lung disease			χ2 test	0.036
No	49 (81.70)	32 (64)
Yes	11 (18.30)	18 (36)
Hypertension			χ2 test	0.385
No	36 (60)	34 (68)
Yes	24 (40)	16 (32)
Diabetes			χ2 test	0.541
No	49 (81.70)	43 (86)
Yes	11 (18.30)	7 (14)
ASA class			χ2 test	0.997
1	11 (18.30)	9 (18)
2	38 (63.30)	32 (64)
3	11 (18.30)	9 (18)
4	0 (0)	0 (0)
Tumor location			χ2 test	0.663
Upper	15 (25)	9 (18)
Middle	24 (40)	21 (42)
Lower	21 (35)	20 (40)
cT stage			χ2 test	0.637
1	29 (48.30)	20 (40)
2	23 (38.30)	21 (42)
3	8 (13.30)	9 (18)
4	0 (0)	0 (0)
cN stage			χ2 test	0.905
0	45 (75)	37 (74)
1	15 (25)	13 (26)
2	0 (0)	0 (0)
3	0 (0)	0 (0)
Neoadjuvant therapy			χ2 test	0.610
No	40 (66.70)	31 (62)
Yes	20 (33.30)	19 (38)

BMI: Body mass index; FEV: Forced expiratory volume; FVC: Forced vital capacity; COPD: Chronic obstructive pulmonary disease; ASA: American Society of Anesthesiologists; cT: Clinical T stage; cN: Clinical N stage.

Table 2 Intraoperative, oncological, and analgesic parameters, n (%)/mean ± SD/median (interquartile range)

Variable	Control group	Observation group	Test	P value
Operative time (minutes)	266.78 ± 36.44	234.52 ± 41.53	Welch t	< 0.001
Estimated blood loss (mL)	284.12 ± 75.72	229.36 ± 94.80	Welch t	0.001
ICU stay (hours)	0 (0-39.50)	0 (0-0)	Mann-Whitney U	0.055
ICU admission			χ2 test	0.075
No	36 (60)	38 (76)
Yes	24 (40)	12 (24)
Total lymph nodes harvested	19.98 ± 4.28	19.14 ± 3.89	Welch t	0.282
Positive lymph nodes	0.00 (0.00-1.00)	0.00 (0.00-1.00)	Mann-Whitney U	0.662
PCA use			χ2 test	0.007
No	13 (21.7)	23 (46.0)
Yes	47 (78.3)	27 (54.0)
Rescue analgesic use		χ2 test	0.009
No	31 (51.7)	38 (76.0)
Yes	29 (48.3)	12 (24.0)
Rescue analgesic times	0.00 (0.00-1.00)	0.00 (0.00-0.00)	Mann-Whitney U	0.011

ICU: Intensive care unit; PCA: Patient-controlled analgesia.

Table 3 Primary and key secondary recovery outcomes, n (%)/mean ± SD/median (interquartile range)

Variable	Control group	Observation group	Test	P value
Time to first ambulation (hours)	31 (24.80-36)	25 (20.20-32.50)	Mann-Whitney U	0.002
Time to first flatus (hours)	60.50 (49-72)	58 (50-67.80)	Mann-Whitney U	0.336
Time to first oral intake (hours)	93.50 (84.80-101.20)	74.50 (66.20-87.20)	Mann-Whitney U	4.726e-06
Drain duration (hours)	157 (135-185.20)	132 (104.80-156.80)	Mann-Whitney U	< 0.001
Postoperative LoS (days)	12.60 (10.90-14.80)	11.80 (9.20-13.80)	Mann-Whitney U	0.005
Recovery speed index (z-mean)	0.25 ± 0.52	-0.30 ± 0.39	Welch t	4.534e-09
30-day readmission			χ2 test	0.523
No	53 (88.30)	46 (92)
Yes	7 (11.70)	4 (8)

LoS: Length of stay.

Table 4 Postoperative complications (safety outcomes), n (%)

Variables	Control group	Observation group	Test	P value
Pulmonary complications			Fisher	0.753
No	54 (90)	46 (92)
Yes	6 (10)	4 (8)
Anastomotic leak			Fisher	0.500
No	58 (96.70)	50 (100)
Yes	2 (3.30)	0 (0)
Arrhythmia			Fisher	0.008
No	52 (86.70)	50 (100)
Yes	8 (13.30)	0 (0)
Deep vein thrombosis			Fisher	1.000
No	58 (96.70)	49 (98)
Yes	2 (3.30)	1 (2)
Reoperation			Fisher	0.500
No	58 (96.70)	50 (100)
Yes	2 (3.30)	0 (0)

Table 5 Adjusted analysis for postoperative length of stay by ordinary least squares regression

Predictors	Beta	95%CI	P value
const	16.10	11.09-21.12	< 0.001
Group	-1.49	-2.59 to -0.38	0.009
Age	-0.04	-0.10 to 0.02	0.176
Gender	-0.86	-2.20 to 0.47	0.202
ASA	0.46	-0.45 to 1.37	0.314
FEV1	-0.57	-1.88 to 0.74	0.389
COPD	-0.21	-1.48 to 1.07	0.750
Neoadjuvant	0.70	-0.43 to 1.82	0.222

ASA: American Society of Anesthesiologists; FEV: Forced expiratory volume; COPD: Chronic obstructive pulmonary disease; CI: Confidence interval.

Table 6 Adjusted model for composite postoperative complications

Predictors	OR	95%CI	P value
Surgical approach	0.24	0.07-0.79	0.019
Age (per 1 year)	1.00	0.94-1.06	0.997
Gender (male vs female)	0.64	0.21-1.91	0.425
ASA (per 1 class)	0.52	0.19-1.39	0.191
FEV1 (per 1 L)	0.38	0.10-1.39	0.143
COPD (yes vs no)	1.76	0.50-6.18	0.377
Neoadjuvant therapy (yes vs no)	0.30	0.09-1.01	0.053

Composite postoperative complications refers to the occurrence of any of the following: Pulmonary complications, anastomotic leak, arrhythmia, deep vein thrombosis, and reoperation. Model: Binomial logistic regression adjusted for age, gender, American Society of Anesthesiologists class, forced expiratory volume in 1 second, chronic obstructive pulmonary disease, and neoadjuvant therapy. ASA: American Society of Anesthesiologists; FEV: Forced expiratory volume; COPD: Chronic obstructive pulmonary disease; OR: Odds ratio; CI: Confidence interval.