Factors Affecting Blood Loss During Thoracoscopic Esophagectomy for Esophageal Carcinoma

Abstract

Background: Major intraoperative hemorrhage reportedly predicts unfavorable survival outcomes following surgical resection for esophageal carcinoma (EC). However, the factors predicting the amount of blood lost during thoracoscopic esophagectomy have yet to be sufficiently studied. We sought to identify risk factors for excessive blood loss during video-assisted thoracoscopic surgery (VATS) for EC. Methods: Using simple and multiple linear regression models, we performed retrospective analyses of the associations between clinicopathological/surgical factors and estimated hemorrhagic volume in 168 consecutive patients who underwent VATS-type esophagectomy for EC. Results:The median blood loss amount was 225 mL (interquartile range, 126-380 mL). Abdominal laparotomy (p<0.001), thoracic duct resection (p=0.014), and division of the azygos arch (p<0.001) were significantly related to high volumes of blood loss. Body mass index and operative duration, as continuous variables, were also correlated positively with blood loss volume in simple linear regression. The multiple linear regression analysis identified prolonged operative duration (p<0.001), open laparotomy approach (p=0.003), azygos arch division (p=0.005), and high body mass index (p=0.014) as independent predictors of higher hemorrhage amounts during VATS esophagectomy. Conclusion:As well as body mass index, operation-related factors such as operative duration, open laparotomy, and division of the azygos arch were independently predictive of estimated blood loss during VATS esophagectomy for EC. Laparoscopic abdominal procedures and azygos arch preservation might be minimally invasive options that would potentially reduce intraoperative hemorrhage, although oncological radicality remains an important consideration.

The impact of minimally-invasive esophagectomy operative duration on post-operative outcomes

“…Surgeon skill, experience, and attention to deliberate, efficient surgical maneuvers all impact operative duration. Extended operative and anesthesia time may be uniquely harmful to esophagectomy patients for numerous reasons, including increased blood loss, tenuous conduit perfusion, and protracted single-lung ventilation ( 15 , 18 ).…”

Early experience in minimally invasive esophagectomy for treatment of thoracic esophageal cancer

“…Thoracoscopic mediastinal dissection can be technically di cult due to anatomical, clinicopathological factors (tumor stage) or post-radiochemotherapy adhesions. Thus, hemorrhagic incidents may occur that can be resolved by minimally invasive approach or cause conversion to open surgery (the average conversion rate reported in the literature is 5-7%) [14]. The need for intraoperative blood transfusions is low in patients who received a minimally invasive approach.…”