Expandable versus inflatable mediastinoscopic combined with laparoscopic for radical esophagectomy.

BACKGROUND: A few medical centers have used the "inflatable mediastinoscope" technology in radical esophagectomy for esophageal cancer, and its safety and short-term efficacy have been limitedly verified. However, this technology has some defects. Therefore, we developed a new method for radical resection of esophageal cancer: the expanded mediastinoscopic combined with laparoscopic radical esophagectomy (EMLE). METHODS: From June 2019 to June 2022, we successfully performed 176 cases of radical resection of esophageal cancer using the new EMLE technique and recorded the baseline and perioperative patient data. We also retrieved four published clinical studies on the inflatable mediastinoscopic combined with laparoscopic radical esophagectomy (IMLE) and compared the perioperative safety differences between EMLE and IMLE. RESULTS: The EMLE group comprised 176 patients, whereas the IMLE group had 173 patients. Compared to IMLE, patients undergoing EMLE showed almost no differences in baseline characteristics but demonstrated significant advantages in terms of operative time (329.71 vs. 168.84 min) and blood loss (167.84 vs. 94.87 mL) (P < 0.001). The incidence of postoperative complications was significantly lower in the EMLE group compared to the IMLE group (P < 0.001). Specifically, the incidence of postoperative recurrent laryngeal nerve palsy was significantly lower in the EMLE group than in the IMLE group (P < 0.001). No significant differences existed in the days of the postoperative hospital stay and number of resected lymph nodes. CONCLUSION: EMLE has no disadvantages compared with IMLE. It is a radical resection of esophageal cancer with more advantages in surgical operation and blood loss control and is also worth promoting.