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Wei HT, Zhang S, Liu YY, Zhang HF, Wang XL, Li L. Evaluation of the clinical effect of inflatable mediastinoscopy synchronous laparoscopic radical resection of esophageal cancer: a comparative study. Eur J Med Res 2025; 30:287. [PMID: 40229843 PMCID: PMC11998396 DOI: 10.1186/s40001-025-02550-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 04/03/2025] [Indexed: 04/16/2025] Open
Abstract
OBJECTIVE To explore the technical innovation and clinical application effect of inflatable mediastinoscopy synchronous laparoscopic radical resection of esophageal cancer. METHODS The clinical data of 180 patients with esophageal cancer treated by the same surgical team from January 2018 to December 2019 were retrospectively analyzed. The patients were divided into the inflatable mediastinoscopy synchronous laparoscopic group (n = 93) and the McKeown group (n = 87) according to the surgical approach. Preoperative general baseline data, perioperative indices, postoperative indices, and short- and long-term survival rates were recorded and statistically analyzed for both groups. RESULTS Compared to McKeown's procedure, the inflatable mediastinoscopy synchronized laparoscopic esophagectomy was associated with relatively less operative time, blood loss, and hospital stay, specifically (94.46 ± 20.17) minutes, (36.76 ± 16.63)ml, and (13.63 ± 2.57) days, respectively. At the same time, the postoperative complication rate of the inflatable mediastinoscopy synchronized laparoscopic esophagectomy was low compared to the postoperative complication rate of McKeown's procedure. CONCLUSION Compared with the traditional McKeown procedure, the patients treated with inflatable mediastinoscopy synchronous laparoscopic radical resection of esophageal cancer have a lower incidence of thoracic complications, shorter operation time, less pain, and faster postoperative recovery so that it can be used as a new supplementary method for mainstream McKeown radical resection of esophageal cancer.
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Affiliation(s)
- Hai-Tao Wei
- Department of Thoracic Surgery, Huaihe Hospital, Henan University, Kaifeng, 475001, Henan, China
| | - Sa Zhang
- College of Nursing and Health, Henan University, Kaifeng, 475001, Henan, China
| | - Yang-Yang Liu
- College of Nursing and Health, Henan University, Kaifeng, 475001, Henan, China
| | - Hai-Feng Zhang
- Department of Thoracic Surgery, Huaihe Hospital, Henan University, Kaifeng, 475001, Henan, China
| | - Xiao-Long Wang
- Department of Thoracic Surgery, Huaihe Hospital, Henan University, Kaifeng, 475001, Henan, China
| | - Li Li
- Department of Thoracic Surgery, Huaihe Hospital, Henan University, Kaifeng, 475001, Henan, China.
- College of Nursing and Health, Henan University, Kaifeng, 475001, Henan, China.
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Yamamoto Y, Morimura R, Imamura T, Ikoma H, Fujiwara H, Shiozaki A, Konishi H, Nanishi K, Kiuchi J, Shimizu H, Arita T, Kuriu Y, Kubota T, Otsuji E. Utility of Laparoscopic Distal Pancreatectomy Following Esophagectomy With Gastric Roll Reconstruction Through the Retrosternal Route. Asian J Endosc Surg 2025; 18:e70039. [PMID: 40044121 DOI: 10.1111/ases.70039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2024] [Revised: 02/04/2025] [Accepted: 02/12/2025] [Indexed: 05/13/2025]
Abstract
BACKGROUND Esophagectomy with gastric roll reconstruction through the retrosternal route can result in significant anatomical shifts in the pancreatic head and neck. These shifts must be carefully considered when planning distal pancreatectomy (DP) after esophagectomy. METHODS We analyzed 15 patients who underwent CT scans after discharge following esophagectomy with gastric roll reconstruction via the retrosternal route. Using CT images, we examined the anatomical features necessary to safely perform DP after esophagectomy. RESULTS The horizontal distances from the vertebral body to the superior mesenteric vein (SMV), superior mesenteric artery (SMA), and gastroduodenal artery (GDA) post-esophagectomy were 12.0, 21.7, and - 4.0 mm, respectively, indicating significant leftward shifts compared with preoperative measurements (SMV: 2.7 mm, p = 0.023; SMA: 9.2 mm, p = 0.046; GDA: -17.5 mm, p < 0.001). The angles between the horizontal line through the center of the SMA and the line connecting the SMA to the SMV (34.5°) and GDA (34.7°) were wider compared with the preoperative SMV (18.4°, p = 0.050) and GDA (17.9°, p = 0.018). Based on sagittal CT sections, the distance between the caudal edge of the gastric roll and the xiphoid process was 100.7 mm. VIDEO PRESENTATION We present a case of laparoscopic DP for pancreatic tail cancer after esophagectomy with gastric roll reconstruction via the retrosternal route. CONCLUSION The altered vascular positioning and the presence of the gastric roll make minimally invasive approaches, particularly laparoscopic DP, advantageous, as they reduce the risk of damaging the gastric roll and the right gastroepiploic artery (RGEA).
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Affiliation(s)
- Yusuke Yamamoto
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryo Morimura
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Taisuke Imamura
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hisashi Ikoma
- Department of Surgery, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Hitoshi Fujiwara
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsushi Shiozaki
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hirotaka Konishi
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Nanishi
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Jun Kiuchi
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroki Shimizu
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomohiro Arita
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshiaki Kuriu
- Department of Surgery, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Takeshi Kubota
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Surgery, Kyoto First Red Cross Hospital, Kyoto, Japan
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Filz von Reiterdank ICLJ, Defize IL, de Groot EM, Wedel T, Grimminger PP, Egberts JH, Stein H, Ruurda JP, van Hillegersberg R, Bleys RLAW. The surgical anatomy of a (robot-assisted) minimally invasive transcervical esophagectomy. Dis Esophagus 2022; 36:6758199. [PMID: 36222066 DOI: 10.1093/dote/doac072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/26/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Transcervical esophagectomy allows for esophagectomy through transcervical access and bypasses the thoracic cavity, thereby eliminating single lung ventilation. A challenging surgical approach demands thorough understanding of the encountered anatomy. This study aims to provide a comprehensive overview of surgical anatomy encountered during the (robot-assisted) minimally invasive transcervical esophagectomy (RACE and MICE). METHODS To assess the surgical anatomy of the lower neck and mediastinum, MR images were made of a body donor after, which it was sliced at 24-μm intervals with a cryomacrotome. Images were made every 3 slices resulting in 3.200 images of which a digital 3D multiplanar reconstruction was made. For macroscopic verification, microscopic slices were made and stained every 5 mm (Mallory-Cason). Schematic drawings were made of the 3D reconstruction to demonstrate the course of essential anatomical structures in the operation field and identify anatomical landmarks. RESULTS Surgical anatomy 'boxes' of three levels (superior thoracic aperture, upper mediastinum, subcarinal) were created. Four landmarks were identified: (i) the course of the thoracic duct in the mediastinum; (ii) the course of the left recurrent laryngeal nerve; (iii) the crossing of the azygos vein right and dorsal of the esophagus; and (iv) the position of the aortic arch, the pulmonary arteries, and veins. CONCLUSIONS The presented 3D reconstruction of unmanipulated human anatomy and schematic 3D 'boxes' provide a comprehensive overview of the surgical anatomy during the RACE or MICE. Our findings provide a useful tool to aid surgeons in learning the complex anatomy of the mediastinum and the exploration of new surgical approaches such as the RACE or MICE.
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Affiliation(s)
| | - I L Defize
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E M de Groot
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T Wedel
- Institute of Anatomy, Center of Clinical Anatomy, Kurt Semm Center for Minimal Invasive and Robotic Surgery, Kiel University, Kiel, Germany
| | - P P Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - J H Egberts
- Department of Surgery, Jewish Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Stein
- Department of Surgical Applications Engineering, Intuitive Surgical, Sunnyvale CA, USA
| | - J P Ruurda
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R van Hillegersberg
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
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Shen Y, Zhang Y, He M, Fang Y, Wang S, Zhou P, Tan L, Lerut T. Advancing Gastroscope From Intraluminal to Extraluminal Dissection: Primary Experience of Laparo-gastroscopic Esophagectomy. Ann Surg 2022; 275:e659-e663. [PMID: 35129533 PMCID: PMC8906244 DOI: 10.1097/sla.0000000000005229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Transhiatal esophagectomy facilitates esophageal resection without the need for thoracotomy. However, this procedure carries the risks of blind and blunt dissection within the mediastinum. More recently, video-assisted or mediastinoscopic transhiatal esophagectomy was introduced to mobilize the esophagus under direct visualization. Even though, the procedure is technically demanding and animal studies have shown that the CO2 pneumomediastinum may be associated with hemodynamic instability. By further developing already established techniques, we pioneered the transhiatal esophageal mobilization by using hybrid gastroscope (Fig. 1). Laparo-gastroscopic esophagectomy, which integrates gastroscope and laparoscope for esophageal mobilization, was successfully implemented on an esophageal cancer patient with a history of lung cancer surgery. The operative duration was 240 minutes with an estimated blood loss of 110 mL. The patient experienced an uneventful recovery and was discharged on postoperative day 9. Further studies will be required to confirm the surgical and oncological efficacy of this innovation.
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Affiliation(s)
- Yaxing Shen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 10021, China
| | - Yiqun Zhang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Mengjiang He
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yong Fang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China
| | - Shuai Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China
| | - Pinghong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China
| | - Toni Lerut
- Department of Thoracic Surgery, University of Leuven, Leuven, Belgium
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Chen Z, Huang K, Wei R, Liu C, Fang Y, Wu B, Xu Z, Ding X, Tang H. Transcervical inflatable mediastinoscopic esophagectomy versus thoracoscopic esophagectomy for local early‐ and intermediate‐stage esophageal squamous cell carcinoma: A propensity score‐matched analysis. J Surg Oncol 2022; 125:839-846. [PMID: 35066884 PMCID: PMC9304140 DOI: 10.1002/jso.26798] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 01/31/2023]
Abstract
Background and objective Transcervical inflatable mediastinoscopic esophagectomy (TIME) is a novel method of minimally invasive esophagectomy (MIE) for esophageal cancer. However, whether TIME is effective and feasible as conventional MIE remains unclear. This study aimed to evaluate the efficacy of TIME by comparing it with thoracoscopic esophagectomy (TE). Methods Surgical outcomes and relapse‐free survival (RFS) rates of patients with local early‐ or intermediate‐stage thoracic esophageal squamous cell carcinoma that underwent TIME or TE from January 2017 to December 2019 were analyzed in this retrospective study. Propensity score matching was used to control the confounding factors. Results The mean operation time in TIME was shorter than that in TE (p < 0.05). Patients in the TIME group achieved postoperative ambulation earlier than those in the TE group (p < 0.05). The rate of pulmonary complications was lower in TIME than in TE (p < 0.05). The number of lymph nodes harvested during surgery and the RFS rates of two groups did not have significant differences. Conclusion TIME may be a feasible and safe method to treat local early‐ and intermediate‐stage thoracic esophageal squamous cell carcinoma effectively and it could be a supplementary surgical method of TE for patients with poor pulmonary function or cannot undergo TE.
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Affiliation(s)
- Zihao Chen
- Department of Minimally Invasive Thoracic Surgery Center Second Affiliated Hospital of Naval Medical University Shanghai China
| | - Kenan Huang
- Department of Minimally Invasive Thoracic Surgery Center Second Affiliated Hospital of Naval Medical University Shanghai China
| | - Rongqiang Wei
- Department of Minimally Invasive Thoracic Surgery Center Second Affiliated Hospital of Naval Medical University Shanghai China
| | - Chengdong Liu
- Department of Minimally Invasive Thoracic Surgery Center Second Affiliated Hospital of Naval Medical University Shanghai China
| | - Yunhao Fang
- Department of Minimally Invasive Thoracic Surgery Center Second Affiliated Hospital of Naval Medical University Shanghai China
| | - Bin Wu
- Department of Thoracic Surgery Second Affiliated Hospital of Naval Medical University Shanghai China
| | - Zhifei Xu
- Department of Minimally Invasive Thoracic Surgery Center Second Affiliated Hospital of Naval Medical University Shanghai China
| | - Xinyu Ding
- Department of Minimally Invasive Thoracic Surgery Center Second Affiliated Hospital of Naval Medical University Shanghai China
| | - Hua Tang
- Department of Minimally Invasive Thoracic Surgery Center Second Affiliated Hospital of Naval Medical University Shanghai China
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Zhu S, Zhang G, You Q, Li F, Ding B, Liu F, Ma T. Sternal lifting increases the operating space in esophagectomy via mediastinoscopy: a prospective cohort study. J Thorac Dis 2021; 13:5546-5555. [PMID: 34659820 PMCID: PMC8482327 DOI: 10.21037/jtd-21-1406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/15/2021] [Indexed: 11/20/2022]
Abstract
Background Esophagectomy with combined single-port inflatable mediastinoscopy and laparoscopy reduces the risk of postoperative respiratory complications as it obviates the need to pass through the pleural space. However, it has strict indications owing to the narrow space for operation. Therefore, we adopted a sternal lifting method using a retractor that enables the expansion of the operating space, a technique which has not been previously reported. We describe our experience and report the results of an evaluation of this new approach. Methods Thirty-nine patients with esophageal squamous cell carcinomas underwent esophagectomy using combined single-port inflatable mediastinoscopy and laparoscopy from March 2019 to August 2021. Among them, 20 cases received sternal suspension [sternal suspension group (SS group)], and 19 cases did not receive sternal suspension [non-sternal suspension group (NSS group)]. The short-term efficacy of the two groups was observed. Results Patients in the SS group had a shorter intramediastinal operation time (82.50 vs. 110.00 minutes; P<0.001), more dissected chest lymph nodes (14 vs. 12; P=0.036), and a lower incidence of postoperative hoarseness (2 vs. 6; P=0.235) than did those in the NSS group. There were no significant differences between the SS group and NSS group in terms of intraoperative blood loss, postoperative hospital stay, post-surgical pathologic TNM classification (pTNM), post-surgical pathologic tumor classification (pT), post-surgical pathologic extent of lymph node involvement (pN), and total number of dissected lymph nodes. There were no statistical differences in the incidence of anastomotic fistula, respiratory complications, arrhythmia, or chylothorax between the two groups. There was no mortality during hospitalization in the two groups. Conclusions Sternal lifting increases the working space in esophagectomy via mediastinoscopy. It can make video-assisted radical esophagectomy by a transmediastinal approach with total pneumomediastinum assistance (VARETT) easier to perform, and sternal suspension in VARETT is safe and effective.
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Affiliation(s)
- Shaojin Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Gengxin Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Qi You
- Department of Thoracic Surgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Fei Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Boying Ding
- Department of Thoracic Surgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Feng Liu
- Department of Thoracic Surgery, Lishui Branch of Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Tongjun Ma
- School of Forensic Medicine, Wannan Medical College, Wuhu, China
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Ye H, Wang X, Li X, Gan X, Zhong H, Wu X, Cao Q. Effect of single-port inflatable mediastinoscopy simultaneous laparoscopic-assisted radical esophagectomy on respiration and circulation. J Cardiothorac Surg 2021; 16:288. [PMID: 34627298 PMCID: PMC8502305 DOI: 10.1186/s13019-021-01671-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 09/25/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND PURPOSE We previously developed a new surgical method, namely, single-port inflatable mediastinoscopy simultaneous laparoscopic-assisted radical esophagectomy. The purpose of this study was to evaluate the effect of carbon dioxide inflation on respiration and circulation using this approach. METHODS From April 2018 to October 2020, 105 patients underwent this novel surgical approach. The changes in respiratory and circulatory functions were reported when the mediastinal pressure and pneumoperitoneum pressure were 10 and 12 mmHg, respectively. Data on blood loss, operative time, and postoperative complications were also collected. RESULTS 104 patients completed the operation successfully, except for 1 patient who was converted to thoracotomy because of intraoperative injury. During the operation, respectively, the heart rate, mean arterial pressure, central venous pressure, peak airway pressure, end-expiratory partial pressure of carbon dioxide and partial pressure of carbon dioxide increased in an admissibility range. The pH and oxygenation index decreased 1 h after inflation, but these values were all within a safe and acceptable range and restored to the baseline level after CO2 elimination. Postoperative complications included anastomotic fistula (8.6%), pleural effusion that needed to be treated (8.6%), chylothorax (0.9%), pneumonia (7.6%), arrhythmia (3.8%) and postoperative hoarseness (18.2%). There were no cases of perioperative death. CONCLUSIONS When the inflation pressure in the mediastinum and abdomen was 10 mmHg and 12 mmHg, respectively, the inflation of carbon dioxide from single-port inflatable mediastinoscopy simultaneous laparoscopic-assisted radical esophagectomy did not cause serious changes in respiratory and circulatory function or increase perioperative complications.
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Affiliation(s)
- Haibo Ye
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China
- Department of Anesthesia, The Fifth Affiliated Hospital of Sun Yat-Sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China
| | - Xiaojin Wang
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China
| | - Xiaojian Li
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China
| | - Xiangfeng Gan
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China
| | - Hongcheng Zhong
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China
| | - Xiangwen Wu
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China.
| | - Qingdong Cao
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China.
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Takeda FR, Obregon CDA, Navarro YP, Moura DTH, Ribeiro Jr U, Aissar Sallum RA, Cecconello I. Thoracoscopic esophagectomy is related to better outcomes in early adenocarcinoma of esophagogastric junction tumors. World J Gastrointest Endosc 2021; 13:319-328. [PMID: 34512879 PMCID: PMC8394183 DOI: 10.4253/wjge.v13.i8.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/21/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Thoracoscopic esophagectomy is related to an extended lymphadenectomy, and a high number of retrieved lymph nodes, compared to the transhiatal approach; however, its association with an improvement in overall survival (OS) is debatable. AIM To compare thoracoscopic esophagectomy with transhiatal esophagectomy in patients with adenocarcinoma of the esophagogastric junction (AEGJ) in terms of survival, number of lymph nodes, and complications. METHODS In total, 147 patients with AEGJ were selected retrospectively from 2002 to 2019, and divided into Group A for thoracoscopic esophagectomy, and group B for transhiatal esophagectomy. OS, disease-free survival, postoperative complications, and number of nodes, were similarly evaluated. RESULTS One hundred and thirty (88%) were male; the mean age was 64 years. Group A had a mean age of 61.1 years and group B 65.7 years (P = 0.009). Concerning the extent of lymphadenectomy, group A showed a higher number of retrieved lymph nodes (mean of 31.89 ± 8.2 vs 20.73 ± 7; P < 0.001), with more perioperative complications, such as hoarseness, surgical site infections, and respiratory complications. Although both groups had similar OS rates, subgroup analysis showed better survival of transthoracic esophagectomy in patients with earlier diseases. CONCLUSION Both methods are safe, having similar morbidity and mortality rates. Transthoracic thoracoscopic esophagectomy allows a more extensive resection of the lymph nodes and may have better oncological outcomes during earlier stages of the disease. Prospective studies are warranted to better evaluate these findings.
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Affiliation(s)
- Flavio Roberto Takeda
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo 05403-000, Brazil
| | | | - Yasmin Peres Navarro
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo 05403-000, Brazil
| | | | - Ulysses Ribeiro Jr
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo 05403-000, Brazil
| | | | - Ivan Cecconello
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo 05403-000, Brazil
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Hoshino A, Tokunaga M, Kinugasa Y. Totally Laparoscopic Transhiatal Middle and Lower Mediastinal Lymphadenectomy for Esophageal Cancer. Surg Laparosc Endosc Percutan Tech 2021; 31:808-811. [PMID: 34091482 DOI: 10.1097/sle.0000000000000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/04/2021] [Indexed: 11/26/2022]
Abstract
Laparoscopic transhiatal approach to esophagectomy with mediastinal lymphadenectomy usually involves hand-assisted laparoscopic surgery. However, a totally laparoscopic approach can decrease the size of the abdominal wound and curtail the impact on respiration. We present a novel, totally laparoscopic transhiatal technique that may reduce respiratory complications following thoracoscopic esophagectomy. We performed a series of combined, thoracoscopic and laparoscopic, McKeown esophagectomies via a neck-abdominal first approach. Middle and lower mediastinal lymphadenectomy, subtracheal lymph node removal, and esophageal mobilization were performed via a totally laparoscopic transhiatal approach. Subsequently, upper mediastinal lymph nodes were dissected using a thoracoscopic approach. Finally, an esophagogastric anastomosis was constructed in the neck. For the 36 patients in this series, the median values of the total operative duration and the thoracoscopic portion were 499 minutes (range, 315 to 678 min) and 106 minutes (range, 67 to 243 min), respectively. Postoperative pneumonia occurred in 3 (8.3%) patients. Totally laparoscopic transhiatal approach is feasible for esophageal surgery with acceptable short-term outcomes.
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Affiliation(s)
- Akihiro Hoshino
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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10
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Liu C, Chen Z, Wei R, Huang K, Wu B, Xu Z, Fang Y, Ding X, Tang H. Intra-operative events and countermeasures during esophagectomy via transcervical incision inflatable single-port mediastinoscope combined with laparoscopy. J Thorac Dis 2021; 13:133-139. [PMID: 33569193 PMCID: PMC7867825 DOI: 10.21037/jtd-20-2331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Esophagectomy via transcervical incision inflatable single-port mediastinoscope combined with laparoscopy as a safe and feasible minimally invasive technique has gained attention recently. But the occurrence of Intraoperative events is inevitable. It’s necessary to investigate and discuss the intraoperative events and countermeasures during operation. Methods Intraoperative events were retrospectively reviewed in 60 patients who underwent esophagectomy via transcervical incision inflatable single-port mediastinoscope combined with laparoscopy in the recent 3 years. Results There was no perioperative death and no aortic or bronchial injury. Bronchial artery injury occurred in 2 cases (3.34%), bronchial artery combined with azygos vein hemorrhage occurred in 1 case (1.67%). The pleura were injured in 3 cases (5%). Recurrent laryngeal nerve injury was noticed in 7 cases (11.67%). Thoracic duct injury occurred in 1 case (1.67%). Conclusions As a new surgical method, esophagectomy via transcervical incision inflatable single-port mediastinoscope combined with laparoscopy is considered safe and feasible, but requires improvement when compared with traditional surgical methods. Due to the influence of surgical space and with experienced surgeons, the incidence of intraoperative events such as intraoperative bleeding and thoracic duct injury is not dominant when compared with the traditional surgical methods. Thoracic surgeons should continuously improve their clinical knowledge as well as skills. Careful preoperative examination and evaluation of the patients, being familiar with the anatomical structure and various methods, wise selection of energy devices and calmly dealing with all kinds of events are the key factors for successful surgeries with fewer intraoperative events.
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Affiliation(s)
- Chengdong Liu
- Department of Thoracic Surgery, Shanghai Changzheng Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Zihao Chen
- Department of Thoracic Surgery, Shanghai Changzheng Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Rongqiang Wei
- Department of Thoracic Surgery, Shanghai Changzheng Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Kenan Huang
- Department of Thoracic Surgery, Shanghai Changzheng Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Bin Wu
- Department of Thoracic Surgery, Shanghai Changzheng Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Zhifei Xu
- Department of Thoracic Surgery, Shanghai Changzheng Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Yunhao Fang
- Department of Thoracic Surgery, Shanghai Changzheng Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Xinyu Ding
- Department of Thoracic Surgery, Shanghai Changzheng Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Hua Tang
- Department of Thoracic Surgery, Shanghai Changzheng Hospital Affiliated to Second Military Medical University, Shanghai, China
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11
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Chiu PWY, de Groot EM, Yip HC, Egberts JH, Grimminger P, Seto Y, Uyama I, van der Sluis PC, Stein H, Sallum R, Ruurda JP, van Hillegersberg R. Robot-assisted cervical esophagectomy: first clinical experiences and review of the literature. Dis Esophagus 2020; 33:5863451. [PMID: 33241301 DOI: 10.1093/dote/doaa052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/22/2020] [Indexed: 12/11/2022]
Abstract
Pulmonary complications, and especially pneumonia, remain one of the most common complications after esophagectomy for esophageal cancer. These complications are reduced by minimally invasive techniques or by avoiding thoracic access through a transhiatal approach. However, a transhiatal approach does not allow for a full mediastinal lymphadenectomy. A transcervical mediastinal esophagectomy avoids thoracic access, which may contribute to a decrease in pulmonary complications after esophagectomy. In addition, this technique allows for a full mediastinal lymphadenectomy. A number of pioneering studies have been published on this topic. Here, the initial experience is presented as well as a review of the current literature concerning transcervical esophagectomy, with a focus on the robot-assisted cervical esophagectomy procedure.
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Affiliation(s)
- Philip Wai-Yan Chiu
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Hon-Chi Yip
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jan-Hendrik Egberts
- Department for General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, University Hospital Schleswig Holstein, Kiel, Germany
| | - Peter Grimminger
- Department for General, Visceral-, Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | | | - Hubert Stein
- Department of Global Clinical Development, Intuitive Surgical Inc., Sunnyvale CA, USA
| | - Rubens Sallum
- Departament of Gastroenterological Surgery, University of São Paulo, São Paulo, Brazil
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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12
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Liu W, Guo X, Zhao H, Yu X, Wang C, Du L, Wang F, Mu J. Mediastinoscopy-assisted transhiatal esophagectomy versus thoraco-laparoscopic esophagectomy for esophageal cancer: a single-center initial experience. J Thorac Dis 2020; 12:4908-4914. [PMID: 33145064 PMCID: PMC7578494 DOI: 10.21037/jtd-20-1328] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background We aimed to compare mediastinoscopy-assisted transhiatal esophagectomy (MATHE) with thoraco-laparoscopic esophagectomy (TLE) for patients with esophageal cancer in terms of the clinical effectiveness and perioperative complications. Methods In total, 98 patients who underwent esophagectomy consecutively for esophageal squamous cell carcinoma in our center from Jan. 2018 to Dec. 2019 were included in this study. Thirty patients underwent mediastinoscopy-assisted and laparoscopic transhiatal esophagectomy with cervical anastomosis (the MATHE group). The other sixty-eight patients received TLE (the TLE group). Each patient's general conditions and perioperative complications were recorded. Results Patients in the MATHE group were observed to have a higher incidence of postoperative hoarseness than those in the TLE group. There were no significant differences between the MATHE group and the TLE group in regards to the operation time, intraoperative blood loss, number of lymph nodes dissected or postoperative hospital stay. Similarly, no statistically significant differences were observed in the incidence of anastomotic fistula, respiratory complications, or chylothorax or in the conversion rate or in-hospital mortality rate between the two groups. Conclusions The short-term efficacy in the MATHE group was similar to that in the TLE group, although patients in the MATHE group may have had a higher incidence of postoperative hoarseness. Therefore, MATHE may be a feasible and safe surgical procedure for appropriate patients with esophageal cancer.
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Affiliation(s)
- Wenyi Liu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Xiaotong Guo
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Hongbo Zhao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Xin Yu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Chunguang Wang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Longde Du
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Feng Wang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Juwei Mu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.,Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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13
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Yamagata Y, Saito K, Hirano K, Oya M. Long-term outcomes and safety of radical transmediastinal esophagectomy with preoperative docetaxel, cisplatin, and 5-fluorouracil combination chemotherapy for locally advanced squamous cell carcinoma of the thoracic esophagus. World J Surg Oncol 2020; 18:252. [PMID: 32962718 PMCID: PMC7510302 DOI: 10.1186/s12957-020-02023-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/09/2020] [Indexed: 12/14/2022] Open
Abstract
Background It is unknown whether transmediastinal esophagectomy (TME) is an acceptable surgical procedure for locally advanced esophageal squamous cell carcinoma (ESCC). Therefore, we investigated the feasibility of long-term survival after TME with neoadjuvant docetaxel, cisplatin, and 5-fluorouracil combination chemotherapy (DCF therapy). Methods This retrospective, observational study included locally advanced resectable ESCC. All patients received two cycles of preoperative DCF therapy (60 mg/m2 of docetaxel and cisplatin on day 1 and 700 mg/m2/day of 5-FU on days 1–5 in each cycle) followed by radical TME. The main outcomes were survival and the rate of adverse events of chemotherapy and surgery. Results Sixteen patients were included in this study. All patients received two cycles of DCF therapy, followed by surgery. The median follow-up duration of the 16 patients was 35.4 months. The 2-year overall survival (OS) was 93.3% (95% confidence interval [CI], 61.3–99.0), and the 3-year OS was 78.8% (95% CI, 47.3–92.7). The 2-year and 3-year relapse-free survivals were both 73.3% (95% CI, 43.6–89.1). Leukopenia and neutropenia occurred in most patients; however, they were controllable. Fifteen patients completed TME, and one was converted to open transthoracic esophagectomy because of tracheal injury. Three-field dissection was performed for 12 of 16 patients (75%), and R0 resection was achieved in 15 of 16 patients (93.8%). Three cases of grade IIIb chylothorax were observed. There was no mortality in this study. Conclusion Combined neoadjuvant DCF and TME for locally advanced ESCC was safe and less invasive than traditional therapies and had a satisfactory long-term prognosis.
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Affiliation(s)
- Yukinori Yamagata
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minami-Koshigaya, Koshigaya City, Saitama, Japan. .,Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Cyuo-ku, Tokyo, Japan.
| | - Kazuyuki Saito
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minami-Koshigaya, Koshigaya City, Saitama, Japan
| | - Kosuke Hirano
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minami-Koshigaya, Koshigaya City, Saitama, Japan
| | - Masatoshi Oya
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minami-Koshigaya, Koshigaya City, Saitama, Japan
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14
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Wang Z, Mao Y, Gao S, Li Y, Tan L, Daiko H, Liu S, Chen C, Koyanagi K, He J. Lymph node dissection and recurrent laryngeal nerve protection in minimally invasive esophagectomy. Ann N Y Acad Sci 2020; 1481:20-29. [PMID: 32671860 DOI: 10.1111/nyas.14427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/29/2020] [Accepted: 06/16/2020] [Indexed: 12/16/2022]
Abstract
Until now, neoadjuvant therapy plus surgical resection of the primary tumor and potential metastatic lymph nodes (LNs) has been the current optimal treatment for locally advanced thoracic esophageal cancer (EC). LN metastasis is one of the most negative prognostic factors for thoracic esophageal squamous cell carcinoma (ESCC). However, the extent of LN dissection for thoracic ESCC has long been controversial worldwide. LNs along the recurrent laryngeal nerve (RLN) were reported to have the highest frequency of metastases in thoracic ESCC, so lymphadenectomy along the bilateral RLN is necessary but quite challenging because of a high frequency of recurrent nerve palsy and related postoperative complications. With the development of minimally invasive devices and techniques in recent years, minimally invasive esophagectomy (MIE) has been widely applied in EC surgery. The topics of what the optimal extent of lymphadenectomy is and how the recurrent nerve should be well protected during MIE have been debated in recent years. The purpose of our review is specifically to address the patterns of LN metastasis, the extent of LN dissection, and the protection of the RLN in MIE for thoracic ESCC.
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Affiliation(s)
- Zhen Wang
- Department of Thoracic Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yin Li
- Department of Thoracic Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hiroyuki Daiko
- Esophageal Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Shuoyan Liu
- Department of Thoracic Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Kazuo Koyanagi
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Tokyo, Japan
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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15
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Yin Q, Liu H, Song Y, Zhou S, Yang G, Wang W, Qie P, Xun X, Liu L. Clinical application and observation of single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal squamous cell carcinoma. J Cardiothorac Surg 2020; 15:125. [PMID: 32503651 PMCID: PMC7275589 DOI: 10.1186/s13019-020-01168-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/24/2020] [Indexed: 11/19/2022] Open
Abstract
Background Transthoracic esophagectomy is a crucial independent risk factor for the incidence of postoperative cardiopulmonary complications in elderly or comorbid patients. To reduce postoperative cardiopulmonary complications and promote postoperative recovery. We made an attempt to adopt the single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal cancer to observe the clinical application and effect. Method Data of patients with esophageal carcinoma were collected in the Hebei General Hospital from May 2018 to November 2019. The operation time, surgical blood loss, the number of dissected lymph nodes, duration of drainage tube, duration of time on the ventilator, the length of stay in ICU, postoperative complications, the length of postoperative hospital stay were collected to assess the safety and feasibility of the single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal cancer. Results A total of 22 patients with esophageal cancer were analyzed in our research. There were no cases of conversion to thoracotomy、perioperative death or postoperative cardiopulmonary complications. The average operation time of all enrolled patients was 4.26 ± 0.52 h、The surgical blood loss was 142 ± 36.50 ml、The amount of dissected lymph nodes were 21.6 ± 4.2、The duration of drainage tube was 5.8 ± 2.5 days、The duration of time on the ventilator was 6.5 ± 3.4 h、The length of stay in ICU was 1.2 ± 0.4 days、The postoperative hospital stay was 12.6 ± 2.5 days. Among all the enrolled patients, one patient (4.5%) developed anastomotic fistula on the third day after surgery. Anastomotic stricture was found in 5 patients (22.7%). Pleural effusion was found in 4 cases (18.2%). Recurrent laryngeal nerve injury caused hoarseness or cough after drinking water in 3 cases (13.6%).There was one patient (4.5%) of conversion to laparotomy as the patient had serious peritoneal adhesion. All of the patients were discharged successfully. Conclusion:Our results showed that this surgery of single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal squamous cell carcinoma is safe and feasible. The feasibility and safety could be further and better investigated with a RCT to achieve more conclusive results.
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Affiliation(s)
- Qifan Yin
- Department of Thoracic Surgery, Hebei General Hospital, 348,West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China
| | - Huining Liu
- Department of Thoracic Surgery, Hebei General Hospital, 348,West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China
| | - Yongbin Song
- Department of Thoracic Surgery, Hebei General Hospital, 348,West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China
| | - Shaohui Zhou
- Department of Thoracic Surgery, Hebei General Hospital, 348,West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China
| | - Guang Yang
- Department of Thoracic Surgery, Hebei General Hospital, 348,West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China
| | - Wenhao Wang
- Department of Thoracic Surgery, Hebei General Hospital, 348,West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China
| | - Peng Qie
- Department of Thoracic Surgery, Hebei General Hospital, 348,West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China
| | - Xuejiao Xun
- Department of Thoracic Surgery, Hebei General Hospital, 348,West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China
| | - Lijun Liu
- Department of Thoracic Surgery, Hebei General Hospital, 348,West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China.
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16
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Watanabe M, Otake R, Kozuki R, Toihata T, Takahashi K, Okamura A, Imamura Y. Recent progress in multidisciplinary treatment for patients with esophageal cancer. Surg Today 2020; 50:12-20. [PMID: 31535225 PMCID: PMC6952324 DOI: 10.1007/s00595-019-01878-7] [Citation(s) in RCA: 288] [Impact Index Per Article: 57.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/04/2019] [Indexed: 02/06/2023]
Abstract
Esophageal cancer is one of the most aggressive gastrointestinal cancers. This review focuses on eight topics within the multidisciplinary approach for esophageal cancer. As esophagectomy is highly invasive and likely to impair quality of life, the development of less invasive strategies is expected. Endoscopic resection (ER) of early esophageal cancer is a less invasive treatment for early esophageal cancer. A recent phase II trial revealed that combined ER and chemoradiotherapy (CRT) is efficacious as an esophagus-preserving treatment for cT1bN0 squamous cell carcinoma (SCC). Esophagectomy and definitive CRT are equally effective for patients with clinical stage I SCC in terms of long-term outcome. For locally advanced resectable cancers, multidisciplinary treatment strategies have been established through several clinical trials of neoadjuvant or perioperative treatment. Minimally invasive esophagectomy may improve the outcomes of patients and CRT is a curative-intent alternative to esophagectomy. CRT with 50.4 Gy radiotherapy combined with salvage surgery is a promising option to preserve the esophagus. Induction chemotherapy followed by esophagectomy may improve the outcomes of patients with locally advanced unresectable tumors. Immune checkpoint inhibitors are effective for esophageal cancer, and their introduction to clinical practice is awaited.
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Affiliation(s)
- Masayuki Watanabe
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Reiko Otake
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Ryotaro Kozuki
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tasuku Toihata
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Keita Takahashi
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Akihiko Okamura
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yu Imamura
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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17
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Wang X, Li X, Cheng H, Zhang B, Zhong H, Wang R, Zhong B, Cao Q. Single-Port Inflatable Mediastinoscopy Combined With Laparoscopic-Assisted Small Incision Surgery for Radical Esophagectomy Is an Effective and Safe Treatment for Esophageal Cancer. J Gastrointest Surg 2019; 23:1533-1540. [PMID: 30635830 DOI: 10.1007/s11605-018-04069-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/24/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND We previously developed a novel non-trans thoracic esophagectomy, the single-port inflatable mediastinoscopy combined with laparoscopy for the radical esophagectomy of esophageal cancer. The purpose of this study was to report its therapeutic efficacy and safety. METHODS From May 2016 to August 2017, we have completed 80 cases of radical resection of esophageal carcinoma using this novel surgical technique. The intraoperative findings and postoperative complications were reported. RESULTS The operation was successfully performed in all patients except for one patient switched from laparoscopic-assisted operation to open surgery. The mean operation duration was 191.4 ± 27 min, and the mean intraoperative blood loss was 147.3 ± 28.9 mL. The mean number of removed lymph node was 21.9 ± 4.1. Five patients (6.4%) who had preoperative type I respiratory failure needed to stay in the intensive care unit for 24 h postoperatively. Postoperative complications included anastomotic leakage (8.9%), anastomotic stricture (21.25%), pleural effusion (9%), and hoarseness postoperative hoarseness (18.8%). The incidence of hoarseness at 3 months postoperation was reduced to 3.8%. All the complications were Clavien-Dindo grades I-III. There were no perioperative death and postoperative cardiopulmonary complications. CONCLUSION These results showed that the single-port inflatable mediastinoscopy combined with laparoscopy is feasible for radical esophagectomy and possesses good therapeutic efficacy and safety.
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Affiliation(s)
- Xiaojin Wang
- Department of Cardiothoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China
| | - Xiaojian Li
- Department of Cardiothoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China
| | - Hua Cheng
- Department of Cardiothoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China
| | - Bin Zhang
- Department of Cardiothoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China
| | - Hongcheng Zhong
- Department of Cardiothoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China
| | - Ruiqi Wang
- Department of Cardiothoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China
| | - Beilong Zhong
- Department of Cardiothoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China
| | - Qingdong Cao
- Department of Cardiothoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China.
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18
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Fujiwara H, Sato T, Okada N, Fujita T, Kojima T, Daiko H. Thoracoscopic esophagectomy with three-field lymphadenectomy for thoracic esophageal cancer in a patient with a double aortic arch: a report of a case. Surg Case Rep 2019; 5:80. [PMID: 31098683 PMCID: PMC6522582 DOI: 10.1186/s40792-019-0640-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We encountered an esophageal cancer patient with a double aortic arch (DAA) who underwent radical thoracoscopic esophagectomy with three-field lymph node dissection. A DAA generally makes it difficult to perform upper mediastinal lymph node dissection via both sides of the thoracic cavity. Furthermore, most patients with a DAA have a superior right aortic arch and right-sided descending aorta, which hampers radical esophagectomy with a typical right thoracic approach. We herein report our operative strategy of thoracoscopic esophagectomy via the left side of the thoracic cavity with a preceding cervical procedure. CASE PRESENTATION A 64-year-old man was diagnosed with esophageal squamous cell carcinoma in the upper esophagus at clinical Stage IIB (cT1bN1M0) according to the UICC-TNM classification 7th edition. First, we planned the preceding cervical procedure to complete upper mediastinal lymph node dissection, as the DAA prevented a bilateral thoracic approach to the upper mediastinum. We then planned the left thoracoscopic procedure to perform lymph node dissection below the left aortic arch, as the patient in our case had a right side-dominant DAA and right-sided descending aorta, as is common in such patients. We identified the bilateral recurrent laryngeal nerves during upper mediastinal lymph node dissection in the preceding cervical procedure and ultimately successfully resected the patient's esophageal cancer. CONCLUSION The cervical procedure preceding the left-thoracoscopic approach is reasonable for achieving radical esophagectomy for thoracic esophageal cancer in patients with a DAA.
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Affiliation(s)
- Hisashi Fujiwara
- Department of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan. .,Department of Esophageal Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Takuji Sato
- Department of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan
| | - Naoya Okada
- Department of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan.,Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Takeo Fujita
- Department of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan
| | - Takashi Kojima
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hiroyuki Daiko
- Department of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan.,Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
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19
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Oshikiri T, Takiguchi G, Miura S, Takase N, Hasegawa H, Yamamoto M, Kanaji S, Yamashita K, Matsuda Y, Matsuda T, Nakamura T, Suzuki S, Kakeji Y. Current status of minimally invasive esophagectomy for esophageal cancer: Is it truly less invasive? Ann Gastroenterol Surg 2019; 3:138-145. [PMID: 30923783 PMCID: PMC6422792 DOI: 10.1002/ags3.12224] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/04/2018] [Accepted: 11/11/2018] [Indexed: 12/17/2022] Open
Abstract
Esophagectomy with extended lymphadenectomy remains the mainstay of treatment for localized esophageal cancer. However, it is one of the most invasive procedures with high morbidity. To reduce invasiveness, minimally invasive esophagectomy (MIE), which includes thoracoscopic, laparoscopic, mediastinoscopic, and robotic surgery, is becoming popular worldwide. Thoracoscopic esophagectomy in the prone position is ergonomic for the surgeon and has better perioperative arterial oxygen pressure/fraction of inspired oxygen (P/F) ratio. Thoracoscopic esophagectomy in the left decubitus position is easy to introduce because it is similar to standard right posterolateral open esophagectomy (OE) in position. It has a relatively short operative time. Laparoscopic approach could potentially have a substantial effect on pneumonia prevention under the condition of thoracotomy. Mediastinoscopic surgery has the potential to reduce pulmonary complications because it can avoid a transthoracic procedure. In robotic surgery, in the future, less recurrent laryngeal nerve palsy will be expected as a result of polyarticular fine maneuvering without human tremors. In studies comparing MIE with OE, mediastinoscopic surgery and robotic surgery are usually not included; these studies show that MIE has a longer operative time and less blood loss than OE. MIE is particularly beneficial in reducing postoperative respiratory complications such as atelectasis, despite no dramatic decrease in pneumonia. Reoperation might occur more frequently with MIE. There is no significant difference in mortality rate between MIE and OE. It is important to recognize that the advantages of MIE, particularly "less invasiveness", can be of benefit at facilities with experienced medical personnel.
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Affiliation(s)
- Taro Oshikiri
- Division of Gastrointestinal SurgeryDepartment of SurgeryGraduate School of MedicineKobe UniversityKobeJapan
| | - Gosuke Takiguchi
- Division of Gastrointestinal SurgeryDepartment of SurgeryGraduate School of MedicineKobe UniversityKobeJapan
| | - Susumu Miura
- Division of Gastrointestinal SurgeryDepartment of SurgeryGraduate School of MedicineKobe UniversityKobeJapan
| | - Nobuhisa Takase
- Division of Gastrointestinal SurgeryDepartment of SurgeryGraduate School of MedicineKobe UniversityKobeJapan
| | - Hiroshi Hasegawa
- Division of Gastrointestinal SurgeryDepartment of SurgeryGraduate School of MedicineKobe UniversityKobeJapan
| | - Masashi Yamamoto
- Division of Gastrointestinal SurgeryDepartment of SurgeryGraduate School of MedicineKobe UniversityKobeJapan
| | - Shingo Kanaji
- Division of Gastrointestinal SurgeryDepartment of SurgeryGraduate School of MedicineKobe UniversityKobeJapan
| | - Kimihiro Yamashita
- Division of Gastrointestinal SurgeryDepartment of SurgeryGraduate School of MedicineKobe UniversityKobeJapan
| | - Yoshiko Matsuda
- Division of Gastrointestinal SurgeryDepartment of SurgeryGraduate School of MedicineKobe UniversityKobeJapan
| | - Takeru Matsuda
- Division of Minimally Invasive SurgeryDepartment of SurgeryGraduate School of MedicineKobe UniversityKobeJapan
| | - Tetsu Nakamura
- Division of Gastrointestinal SurgeryDepartment of SurgeryGraduate School of MedicineKobe UniversityKobeJapan
| | - Satoshi Suzuki
- Division of Community Medicine and Medical NetworkDepartment of Social Community Medicine and Health ScienceGraduate School of MedicineKobe UniversityKobeJapan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal SurgeryDepartment of SurgeryGraduate School of MedicineKobe UniversityKobeJapan
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20
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Nakauchi M, Uyama I, Suda K, Shibasaki S, Kikuchi K, Kadoya S, Ishida Y, Inaba K. Robot-assisted mediastinoscopic esophagectomy for esophageal cancer: the first clinical series. Esophagus 2019; 16:85-92. [PMID: 30074105 DOI: 10.1007/s10388-018-0634-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/31/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Radical esophagectomy for esophageal cancer is associated with high morbidity, especially with pulmonary complications. Mediastinoscopic esophagectomy via a small left neck incision combined with the esophageal hiatus, without using transthoracic approach, has been reported to reduce pulmonary complication; however, from technical point of view, this approach using non-articulating, straight, long forceps is extremely challenging, especially in the middle mediastinal area. Its technical difficulties may be attenuated using da Vinci Surgical System. The aim of this study was to evaluate the feasibility and safety of robot-assisted mediastinoscopic esophagectomy. METHODS Robot-assisted mediastinoscopic esophagectomy was performed in six patients between October 2016 and May 2017. Robotic esophageal mobilization with upper and middle mediastinal lymphadenectomy was performed via the three da Vinci Xi (Intuitive Surgical, Inc. Sunnyvale, CA) trocars placed on the 5-cm left cervical incision. Thereafter, the remaining part of radical esophagectomy was completed via a transhiatal approach. RESULTS Upper and middle mediastinal lymphadenectomy was robotically completed via the transcervical approach in all cases without conversion to transthoracic approach. No postoperative complications (Clavien-Dindo classification grade ≥ III) were observed. CONCLUSIONS Robot-assisted mediastinoscopic esophagectomy was technically feasible and safe. Use of da Vinci Surgical System may help attenuate technical difficulties in transcervical middle mediastinal lymph node dissection.
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Affiliation(s)
- Masaya Nakauchi
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Koichi Suda
- Cancer Center, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Susumu Shibasaki
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kenji Kikuchi
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Shinichi Kadoya
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Yoshinori Ishida
- Upper G.I. Division, Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan
| | - Kazuki Inaba
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
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21
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Fujiwara H, Shiozaki A, Konishi H, Otsuji E. Transmediastinal approach for esophageal cancer: A new trend toward radical surgery. Asian J Endosc Surg 2019; 12:30-36. [PMID: 30681280 DOI: 10.1111/ases.12687] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 12/17/2018] [Indexed: 12/24/2022]
Abstract
Esophageal squamous cell carcinoma (ESCC), the most common histology of esophageal cancer in Japan and Asia, shows extensive mediastinal spread from an early stage. Therefore, transthoracic esophagectomy with extensive mediastinal lymphadenectomy, including in the upper mediastinum along the recurrent laryngeal nerves, is the gold standard of radical surgery for ESCC. Minimally invasive thoracoscopic esophagectomy has now become a standard option for ESCC. However, transhiatal esophagectomy is regarded as less invasive because it avoids thoracotomy. Yet, it is also considered less curative because it offers a limited surgical view and insufficient mediastinal lymphadenectomy even when conventional specialized mediastinoscopy is used. Recent clinical studies on radical esophagectomy without thoracotomy for ESCC have been reported from Japan. The introduction of novel minimally invasive techniques for the transcervical or transhiatal approach, such as single-port or robotic surgical devices, have enabled transmediastinal radical esophagectomy for ESCC. This review focuses on the transmediastinal approach for esophageal cancer surgery, which employs minimally invasive techniques to reduce morbidity, and its application to radical surgery for ESCC.
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Affiliation(s)
- Hitoshi Fujiwara
- Department of Surgery, Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsushi Shiozaki
- Department of Surgery, Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hirotaka Konishi
- Department of Surgery, Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eigo Otsuji
- Department of Surgery, Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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22
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Mori K, Ino K, Yoshimura S, Aikou S, Yagi K, Nishida M, Mitsui T, Okumura Y, Yamagata Y, Yamashita H, Nomura S, Seto Y. Mediastinoscopic view of the bronchial arteries in a series of surgical cases evaluated with three-dimensional computed tomography. Esophagus 2018; 15:173-179. [PMID: 29951982 DOI: 10.1007/s10388-018-0609-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/06/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND We have routinely performed three-dimensional computed tomography (3-D CT) prior to video-assisted transmediastinal esophagectomy to evaluate the small arteries in the mediastinal operative field. This evaluation would be helpful in performing mediastinoscopic esophagectomy. METHODS Thirty-one patients who underwent transmediastinal esophagectomy with preoperative evaluations by 3-D CT were the study subject. The bronchial arteries depicted by the 3-D CT were classified by their origin and laterality. In 18 of the 31 cases, the surgical video was available and the identification rate in the video was reviewed for each of the categorized bronchial arteries. RESULTS The detection rates of each classified artery were as follows (abbreviations, detection rate); the intercostal-bronchial trunk (IBT, 22/31), the direct left bronchial artery (LBA, 17/31), the common trunk of bronchial arteries (CTB, 7/31), the direct right bronchial artery (RBA, 2/31), and the ectopic arteries (16/31). The ectopic arteries arose from the aortic arch (11 cases), the right subclavian artery (6 cases) or the left subclavian artery (1 case). The identification rates of IBT, LBA, CTB, RBA and any of the ectopic arteries in the video review were 12/13, 4/8, 3/4, 1/1 and 2/10, respectively. CONCLUSIONS Preoperative 3-D CT was a highly sensitive evaluation for the bronchial arteries encountered during transmediastinal esophagectomy. Orthotopic arteries except for LBA were frequently identified at the predicted sites. Although RBA and CTB were present infrequently, they often flowed into regional nodes at the bilateral bronchi or the tracheal bifurcation and, therefore, should be preoperatively evaluated.
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Affiliation(s)
- Kazuhiko Mori
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Gastrointestinal Surgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kenji Ino
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Shuntaro Yoshimura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Susumu Aikou
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koichi Yagi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masato Nishida
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takashi Mitsui
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasuhiro Okumura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yukinori Yamagata
- Department of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroharu Yamashita
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Sachiyo Nomura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan.
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23
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Fujiwara H, Shiozaki A, Konishi H, Kosuga T, Komatsu S, Ichikawa D, Okamoto K, Otsuji E. Perioperative outcomes of single-port mediastinoscope-assisted transhiatal esophagectomy for thoracic esophageal cancer. Dis Esophagus 2017; 30:1-8. [PMID: 28859387 DOI: 10.1093/dote/dox047] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 04/12/2017] [Indexed: 12/11/2022]
Abstract
We developed an en bloc lymphadenectomy method in the upper mediastinum with a single-port mediastinoscopic cervical approach. This study was designed to evaluate the safety and efficacy of single-port mediastinoscope-assisted transhiatal esophagectomy for thoracic esophageal cancer. The perioperative outcomes of 60 patients with thoracic esophageal cancer who underwent this operation between March 2014 and June 2016 were retrospectively analyzed. The upper mediastinal dissection including lymphadenectomy along the left recurrent laryngeal nerve, using a left cervical approach, was performed with a single-port mediastinoscopic technique, which was used to improve the visibility and handling in the deep mediastinum around the aortic arch. The lymphadenectomy along the right recurrent laryngeal nerve was performed under direct vision using a right cervical approach. Bilateral cervical approaches were followed by hand-assisted laparoscopic transhiatal esophagectomy with en bloc lymphadenectomy in the middle and lower mediastinum. Tumors were mainly located in the middle thoracic esophagus (n = 33), and most tumors were squamous cell carcinoma (n = 58). Pretreatment diagnoses were stage I, 19; II, 13; III, 24; IV, 4. Preoperative chemotherapy was performed for 40 patients. The median operation time and blood loss were 363 minutes and 235 mL, respectively. There were two patients who underwent conversion to thoracotomy. Perioperative complications were evaluated and graded according to the Clavien-Dindo (CD) and the Esophagectomy Complications Consensus Group (ECCG) classifications. Postoperatively, pneumonia was observed in four patients (CD, Grade II, 2; Grade IIIb, 2), although vocal cord palsy was more frequent (ECCG, Type I, 12; Type III, 8). The median number of thoracic lymph nodes resected was 21, and the R0 resection rate was 95%. Single-port mediastinoscope-assisted transhiatal esophagectomy is feasible, in terms of perioperative outcomes, for a radical surgery for thoracic esophageal cancer, although its safety needs to be further demonstrated.
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24
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Fujiwara H, Shiozaki A, Konishi H, Otsuji E. Mediastinoscope and laparoscope-assisted esophagectomy. J Vis Surg 2016; 2:125. [PMID: 29078513 DOI: 10.21037/jovs.2016.07.08] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/30/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Mediastinoscope-assisted transhiatal esophagectomy (MATHE) is a minimally invasive option for thoracic esophageal cancer with the potential benefit of decreasing pulmonary complications by avoiding one-lung ventilation or a transthoracic procedure. However, the conventional MATHE procedure is less radical than transthoracic esophagectomy due to operative view limitations and insufficient mediastinal lymphadenectomy. In upper mediastinal dissection, the conventional MATHE procedure only provides esophageal mobilization with or without lymph node sampling. We developed a novel MATHE procedure with en bloc mediastinal lymphadenectomy by introducing a single-port laparoscopic technique. METHODS The patient was placed in a supine position with bilateral lung ventilation. The upper mediastinal dissection, using a left cervical approach, was performed with a single-port mediastinoscopic technique. A laparoscope was used as a 'mediastinoscope'. The lymph nodes along the right recurrent laryngeal nerve (RLN) were dissected under direct vision using a right cervical approach. Bilateral cervical approaches were followed by hand-assisted laparoscopic transhiatal esophagectomy. RESULTS A single-port technique provides a favorable expansion of the mediastinal space by carbon dioxide insufflation, and improves the visibility and handling in the deep mediastinum around the aortic arch, allowing for en bloc lymphadenectomy in the upper mediastinum including the subaortic arch lymph nodes. In addition, a hand-assisted laparoscopic transhiatal procedure allows for en bloc lymphadenectomy in the middle and lower mediastinum including the subcarinal and bilateral main bronchial lymph nodes. Cervical and transhiatal procedures were performed safely and carefully under video-assisted magnified vision according to the standardized procedure with an appropriate operative field expansion using retractors. CONCLUSIONS Single-port MATHE is feasible as a novel minimally invasive surgery for esophageal squamous cell carcinoma (ESCC) or thoracic esophageal cancer.
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Affiliation(s)
- Hitoshi Fujiwara
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsushi Shiozaki
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hirotaka Konishi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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