Clinical outcomes of harmonic scalpel in esophageal cancer surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Jinming , BAO Feichao , ZHANG Chong , LV Wang ,  HU Jian

Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, P.R.China;

Corresponding author：

HU Jian, Email: dr_hujian@zju.edu.cn

Keywords：

Harmonic scalpel; esophageal cancer; clinical assessment

DOI：

10.7507/1007-4848.201711026

Video：

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Objective To assess the outcome of harmonic scalpel (HS) in esophageal cancer surgery and to provide evidence for the role of HS in the enhanced recovery after surgery (ERAS) and short-term prognosis after esophageal cancer surgery. Methods We collected the clinical data of 81 esophageal cancer patients receiving surgery by HS between January 1 and December 31, 2016 and successfully followed up in our department. There were 67 males and 14 females with an average age of 64.07±7.52 years. Sweet approach was adopted in 16 patients, Ivor-Lewis approach in 23 and McKeown approach in 40. Intrathoracic anastomosis was completed in 41 patients and cervical anastomosis in 40. The length of total hospital stay and postoperative hospital stay, operation time, intraoperative blood loss, duration and volume of thoracic drainage and perioperative complications were recorded and compared in patients with different surgical approaches and anastomosis sites. Results For these 81 patients, the operation time was 276.7±70.4 min, and the intraoperative blood loss was 115.9±69.7 ml. The postoperative duration of thoracic drainage, postoperative complication rate and the drainage volume were 12.3±5.3 d, 35.80% and 1 411.9±1 199.5 ml, respectively. During the follow-up, 15 patients died and the cumulative survival rate was 81.48%. There was no obvious HS-related complication. The operation time of Sweet approach was shorter than that of Ivor-Lewis or McKeown approach (P=0.012) and the dissected lymph nodes were less in Sweet approach (P=0.035). There was no significant difference in perioperative indexes and postoperative short-term prognosis between intrathoracic anastomosis and cervical anastomosis. Conclusion HS is widely used in the surgery for esophageal cancer with safety and effectiveness, which is worthy of clinical application.

Citation： XU Jinming, BAO Feichao, ZHANG Chong, LV Wang, HU Jian. Clinical outcomes of harmonic scalpel in esophageal cancer surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(1): 12-16. doi: 10.7507/1007-4848.201711026 Copy

1.	Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
2.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
3.	Law S, Kwong DL, Kwok KF, et al. Improvement in treatment results and long-term survival of patients with esophageal cancer: impact of chemoradiation and change in treatment strategy. Ann Surg, 2003, 238(3): 339-347.
4.	Ruurda JP, van der Sluis PC, van der Horst S, et al. Robot-assisted minimally invasive esophagectomy for esophageal cancer: A systematic review. J Surg Oncol, 2015, 112(3): 257-265.
5.	Allum WH, Blazeby JM, Griffin SM, et al. Guidelines for the management of oesophageal and gastric cancer. Gut, 2011, 60(11): 1449-1472.
6.	Kato H, Nakajima M. Treatments for esophageal cancer: a review. Gen Thorac Cardiovasc Surg, 2013, 61(6): 330-335.
7.	Waraich N, Ahmed J, Rashid F, et al. Is harmonic scalpel an effective tool for oesophagectomy? Int J Surg, 2009, 7(4): 330-333.
8.	Hayashi A, Takamori S, Matsuo T, et al. Experimental and clinical evaluation of the harmonic scalpel in thoracic surgery. Kurume Med J, 1999, 46(1): 25-29.
9.	White A, Kucukak S, Lee DN, et al. Energy-based ligation of pulmonary vessels: a six-year experience with ultrasonic shears in video-assisted thoracoscopic lobectomy and segmentectomy. Ann Thorac Surg, 2016, 101(4): 1334-1337.
10.	Rice TW, Blackstone EH, Rusch VW. 7th edition of the AJCC Cancer Staging Manual: esophagus and esophagogastric junction. Ann Surg Oncol, 2010, 17(7): 1721-1724.
11.	Yamada S, Yoshino K, Inoue H. New-model ultrasonically activated shears for hemostatic sectioning during video-assisted thoracic surgery. Gen Thorac Cardiovasc Surg, 2007, 55(12): 518-520.
12.	中国医师协会胸外科医师分会微创外科专家委员会, 刘伦旭, 李印, 胡坚, 等. 胸腔镜手术超声刀规范使用专家共识(2017 版). 中国胸心血管外科临床杂志, 2017, 24(6): 407-412.
13.	Page RD, Khalil JF, Whyte RI, et al. Esophagogastrectomy via left thoracophrenotomy. Ann Thorac Surg, 1990, 49(5): 763-766.
14.	Takagi K, Hata Y, Sasamoto S, et al. Late onset postoperative pulmonary fistula following a pulmonary segmentectomy using electrocautery or a harmonic scalpel. Ann Thorac Cardiovasc Surg, 2010, 16(1): 21-25.
15.	Sankaranarayanan G, Resapu RR, Jones DB, et al. Common uses and cited complications of energy in surgery. Surg Endosc, 2013, 27(9): 3056-3072.
16.	Koch C, Friedrich T, Metternich F, et al. Determination of temperature elevation in tissue during the application of the harmonic scalpel. Ultrasound Med Biol, 2003, 29(2): 301-309.

1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
2. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
3. Law S, Kwong DL, Kwok KF, et al. Improvement in treatment results and long-term survival of patients with esophageal cancer: impact of chemoradiation and change in treatment strategy. Ann Surg, 2003, 238(3): 339-347.
4. Ruurda JP, van der Sluis PC, van der Horst S, et al. Robot-assisted minimally invasive esophagectomy for esophageal cancer: A systematic review. J Surg Oncol, 2015, 112(3): 257-265.
5. Allum WH, Blazeby JM, Griffin SM, et al. Guidelines for the management of oesophageal and gastric cancer. Gut, 2011, 60(11): 1449-1472.
6. Kato H, Nakajima M. Treatments for esophageal cancer: a review. Gen Thorac Cardiovasc Surg, 2013, 61(6): 330-335.
7. Waraich N, Ahmed J, Rashid F, et al. Is harmonic scalpel an effective tool for oesophagectomy? Int J Surg, 2009, 7(4): 330-333.
8. Hayashi A, Takamori S, Matsuo T, et al. Experimental and clinical evaluation of the harmonic scalpel in thoracic surgery. Kurume Med J, 1999, 46(1): 25-29.
9. White A, Kucukak S, Lee DN, et al. Energy-based ligation of pulmonary vessels: a six-year experience with ultrasonic shears in video-assisted thoracoscopic lobectomy and segmentectomy. Ann Thorac Surg, 2016, 101(4): 1334-1337.
10. Rice TW, Blackstone EH, Rusch VW. 7th edition of the AJCC Cancer Staging Manual: esophagus and esophagogastric junction. Ann Surg Oncol, 2010, 17(7): 1721-1724.
11. Yamada S, Yoshino K, Inoue H. New-model ultrasonically activated shears for hemostatic sectioning during video-assisted thoracic surgery. Gen Thorac Cardiovasc Surg, 2007, 55(12): 518-520.
12. 中国医师协会胸外科医师分会微创外科专家委员会, 刘伦旭, 李印, 胡坚, 等. 胸腔镜手术超声刀规范使用专家共识(2017 版). 中国胸心血管外科临床杂志, 2017, 24(6): 407-412.
13. Page RD, Khalil JF, Whyte RI, et al. Esophagogastrectomy via left thoracophrenotomy. Ann Thorac Surg, 1990, 49(5): 763-766.
14. Takagi K, Hata Y, Sasamoto S, et al. Late onset postoperative pulmonary fistula following a pulmonary segmentectomy using electrocautery or a harmonic scalpel. Ann Thorac Cardiovasc Surg, 2010, 16(1): 21-25.
15. Sankaranarayanan G, Resapu RR, Jones DB, et al. Common uses and cited complications of energy in surgery. Surg Endosc, 2013, 27(9): 3056-3072.
16. Koch C, Friedrich T, Metternich F, et al. Determination of temperature elevation in tissue during the application of the harmonic scalpel. Ultrasound Med Biol, 2003, 29(2): 301-309.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical outcomes of harmonic scalpel in esophageal cancer surgery

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