To explore the feasibility of combined TV thoracoscopy, laparoscopy and mediastinoscopy for minimally invasive radical treatment of esophageal cancer. From April 2OO4 to May 2OO6, 40 cases of esophageal cancer were radically treated by combined laparoscopy, including 10 cases of open thoracoscopy combined with laparoscopy, 20 cases of small incision-assisted thoracoscopy combined with laparoscopy, 4 cases of mediastinoscopy combined with laparoscopy, and 6 cases of mediastinoscopy combined with open abdomen. The results of 34 cases of laparoscopic free stomach were all successful without bleeding, and (5.5±1.9) abdominal lymph nodes were removed. There were 20 cases of small incision-assisted thoracoscopic radical resection of esophageal cancer, with no intermediate opening and removal of mediastinal lymph nodes (10.3±2.7), 4 cases of postoperative arrhythmia, 1 case of thoracic bleeding and 1 case of functional gastric obstruction; 10 cases of mediastinoscopic esophageal cancer resection, with 1 case of intraoperative bleeding and 3 cases of postoperative hoarseness. 40 cases were followed up for 1-20 months, with no tumor recurrence and metastasis and no No death. Conclusion Combined lumpectomy of esophageal cancer is safe and feasible, and small incision assisted thoracoscopic resection of esophageal cancer takes into account the advantages of open surgery and pure thoracoscopic surgery, and is a surgical method worth promoting. 1.Application of laparoscopy Minimally invasive surgery of esophageal cancer includes minimally invasive resection of esophagus and minimally invasive reconstruction of digestive tract, and laparoscopic free stomach is the basis of minimally invasive reconstruction of digestive tract. In our group, laparoscopic free stomach and lymph node dissection of gastric lesser curvature and paracolic lymph nodes in 32 cases of esophageal cancer were all successful, and there was basically no bleeding during the operation, and the gastric lesser curvature and paracolic lymph nodes were completely dissected. As long as there is no history of abdominal surgery and no large lymph node metastasis in the abdominal cavity, even if the esophageal cancer is invasive and requires open-heart resection, abdominal minimally invasive surgery can achieve the purpose of reducing overall trauma and greatly reduce pulmonary complications, which fully illustrates the superiority of abdominal minimally invasive surgery in accordance with the literature. 2. Combined application of thoracoscopy and laparoscopy Since TV thoracoscopy is used for esophageal disease surgery, the technical method has been perfected day by day, and now it has become the preferred method for the treatment of benign esophageal diseases. We performed small axillary incision-assisted thoracoscopic resection of esophageal cancer, laparoscopic free stomach and right thoracic apex anastomosis of gastroesophagus for 20 patients with middle and lower esophageal cancer, the advantages of which are: small incision-assisted is more favorable to the exposure of mediastinum than simple thoracoscopic surgery; due to the good view of “microscopic surgery”, it is more favorable to the lymph node clearance of the laryngeal nerve travel area on both sides. Compared with conventional open-heart surgery, there is no need to cut the muscles and nerves in the back, so the surgery is less traumatic and the postoperative pain is significantly reduced; combined with TV laparoscopy to free the stomach, there is no open incision in the abdomen, and the abdominal muscle movement is minimally affected during breathing, which is more conducive to the recovery of respiratory function after surgery. In conclusion, this procedure can reduce pulmonary complications and improve the safety of surgery to a certain extent. It is suitable for middle and lower esophageal cancer without obvious external invasion, i.e. middle and lower esophageal cancer with the upper margin of the tumor >8 cm from the right thoracic apex; no direct invasion of adjacent tissues (≤1r3 stage); no large lymph node metastasis in the esophageal bed and gastric lesser curvature; intraoperative tolerance to ventilation of one lung on the left side; and no history of thoracic or abdominal surgery. The method to prevent postoperative functional gastric obstruction is to endoscopically cut the lower mediastinal pleura, first suture the edge of the mediastinal pleura together with the lower pulmonary ligament and reserve sutures, and after completing the anastomosis, press the thoracic stomach toward the mediastinum with a five-pronged pulling hook and ligate the reserved sutures to make the thoracic stomach close the mediastinum smoothly, which can prevent the occurrence of gastric obstruction. 3. Combined application of mediastinoscopy and laparoscopy Mediastinoscopic esophageal cancer resection can free the esophagus under image surveillance, clearly observe the organs in the mediastinum and the enlarged lymph nodes beside the esophagus, and can be separated and removed with instruments, the biggest advantage of which is to avoid the blindness of traditional esophageal extraction¨, thus effectively reducing the bleeding, damage to the laryngeal recurrent nerve and thoracic duct. Although theoretically mediastinoscopic esophagectomy without open chest may reduce the incidence of postoperative pulmonary complications, it was found that the difference between the incidence of postoperative pulmonary infection and that of traditional open chest surgery was not statistically significant J, and the reasons for this deserve to be explored. Mediastinoscopic esophagectomy without pulmonary atrophy is more suitable for patients with extremely poor lung function; therefore, patients whose lung function cannot tolerate open surgery, i.e., those who are suitable for esophageal inversion and extraction, are absolute indications for mediastinoscopic esophagectomy, and upper segment esophageal cancer without external invasion, especially cervicothoracic junction esophageal cancer, where mediastinoscopic surgery with a cervical incision is superior to open esophageal cancer resection, is also an indication for mediastinoscopic esophagectomy. At present, we have completed only 4 cases of TV mediastinoscopic combined with laparoscopic transdiaphragmatic esophagectomy, which also has the advantages reported in the above literature. Moreover, the lymph nodes under the bulge and lobe ligament group can be cleared after laparoscopic upstream freeing of the esophagus to the tracheal bifurcation plane through the diaphragmatic fissure, which makes up for the shortage of simple mediastinoscopic surgery, but further experience is needed. In conclusion, radical lumpectomy for esophageal cancer is increasingly recognized for its advantages of minimally invasive, less bleeding, less pain, fewer postoperative complications and shorter hospital stay. Axillary small incision assisted TV thoracoscopy combined with laparoscopic radical esophageal cancer treatment takes into account the advantages of open surgery and simple thoracoscopic surgery, and the surgical trauma is similar to that of simple thoracoscopic surgery, while small incision assisted surgery is more conducive to the exposure of mediastinum than simple thoracoscopic surgery, which improves the thoroughness of tumor resection, lymph node dissection and surgical safety.