Long-term outcomes of mediastinoscopic esophagectomy in early esophageal squamous cell carcinoma: 269 cases study

BACKGROUND: Studies in larger populations and long-term outcomes of Mediastinoscopic esophagectomy (ME) were needed. The aim of this study was to report the long-term survival and surgical process for reducing the postoperative complications after ME. METHODS: From December 2005 to March 2018, 269 patients diagnosed with esophageal squamous cell carcinoma were participated for ME in our center, while we improved the surgical process in November 1st 2014, clinical data was collected and analyzed. RESULTS: The overall survival rate after ME was 60.3% at 10-year and 69.2% at 5-year, and the survival curve was markedly associated with T and N stages. N(2–3) stage resulted in lower survival time, while the median survival was 36 months. After Nov. 2014, the positive rate of lymph nodes around left recurrent laryngeal nerve (LRLN) was increased from 6.7% to 14.5% (P<0.05), and the morbidity of vocal cord paralysis decreased from 9.8% to 3.9% (P<0.05), while the incidence of anastomotic fistula decreased from 15% to 5.3% in ME (P<0.05), compared with the data before Nov. 2014. CONCLUSIONS: ME was an effective surgical method for esophageal cancer. The processes of isolating and marking the LRLN and reinforcing the posterior wall of anastomosis were proved valuable for improvement of postoperative complications.