The usefulness of three-dimensional video-assisted thoracoscopic esophagectomy in esophageal cancer patients

Abstract Description Video-assisted transcervical approach may be promising for the upper mediastinal lymphadenectomy in patients with esophageal cancer. However, it is difficult to recognize positioning of landmark organs, such as the bronchus, recurrent nerves, and major vessels, since the operating field is unfamiliar for most surgeons and any anatomical charts have failed to show. Using a technique of the computer graphics, we have created three-dimensional animation illustrating the upper mediastinal anatomy which includes stepwise positional change of such landmark organs depending on progress of the dissection of the esophagus. This animation clip will become a useful tool for education for surgeons who introduce transcervical approach in upper mediastinal lymphadenectomy in video-assisted esophageal cancer surgery. Disclosure All authors have declared no conflicts of interest.

Download Full-text

Video-assisted thoracoscopic esophagectomy in the left lateral decubitus position in an esophageal cancer patient with pectus excavatum

Asian Journal of Endoscopic Surgery ◽

10.1111/ases.12195 ◽

2015 ◽

Vol 8 (3) ◽

pp. 333-336 ◽

Cited By ~ 2

Author(s):

Shinsuke Sato ◽

Erina Nagai ◽

Hiroyuki Hazama ◽

Yusuke Taki ◽

Michiro Takahashi ◽

...

Keyword(s):

Esophageal Cancer ◽

Cancer Patient ◽

Pectus Excavatum ◽

Esophageal Cancer Patient ◽

Lateral Decubitus Position ◽

Thoracoscopic Esophagectomy ◽

Video Assisted ◽

Left Lateral Decubitus Position ◽

Lateral Decubitus

Download Full-text

603. Thoracoscopic esophagectomy with total mediastinal lymphadenectomy in esophageal cancer patients with near complete response to neoadjuvant chemoradiotherapy: Feasibility and significance

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2016.06.323 ◽

2016 ◽

Vol 42 (9) ◽

pp. S180

Author(s):

R. Kalayarasan

Keyword(s):

Esophageal Cancer ◽

Cancer Patients ◽

Neoadjuvant Chemoradiotherapy ◽

Complete Response ◽

Thoracoscopic Esophagectomy ◽

Mediastinal Lymphadenectomy

Download Full-text

Changes in respiratory mechanics of artificial pneumothorax two-lung ventilation in video-assisted thoracoscopic esophagectomy in prone position

Scientific Reports ◽

10.1038/s41598-021-86554-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yoshinori Tanigawa ◽

Kimihide Nakamura ◽

Tomoko Yamashita ◽

Akira Nakagawachi ◽

Yoshiro Sakaguchi

Keyword(s):

Esophageal Cancer ◽

Prone Position ◽

Respiratory Mechanics ◽

Lung Ventilation ◽

Thoracoscopic Esophagectomy ◽

Secondary Outcome ◽

One Lung Ventilation ◽

Cancer Data ◽

Video Assisted ◽

Artificial Pneumothorax

AbstractWe aimed to clarify the changes in respiratory mechanics and factors associated with them in artificial pneumothorax two-lung ventilation in video-assisted thoracoscopic esophagectomy in the prone position (PP-VATS-E) for esophageal cancer. Data of patients with esophageal cancer, who underwent PP-VATs-E were retrospectively analyzed. Our primary outcome was the change in the respiratory mechanics after intubation (T1), in the prone position (T2), after initiation of the artificial pneumothorax two-lung ventilation (T3), at 1 and 2 h (T4 and T5), in the supine position (T6), and after laparoscopy (T7). The secondary outcome was identifying factors affecting the change in dynamic lung compliance (Cdyn). Sixty-seven patients were included. Cdyn values were significantly lower at T3, T4, and T5 than at T1 (p < 0.001). End-expiratory flow was significantly higher at T4 and T5 than at T1 (p < 0.05). Body mass index and preoperative FEV1.0% were found to significantly influence Cdyn reduction during artificial pneumothorax and two-lung ventilation (OR [95% CI]: 1.29 [1.03–2.24] and 0.20 (0.05–0.44); p = 0.010 and p = 0.034, respectively]. Changes in driving pressure were nonsignificant, and hypoxemia requiring treatment was not noted. This study suggests that in PP-VATs-E, artificial pneumothorax two-lung ventilation is safer for the management of anesthesia than conventional one-lung ventilation (UMIN Registry: 000042174).

Download Full-text

RA03.07: LEARNING CURVE FOR ROBOTIC AND VIDEO-ASSISTED THORACOSCOPIC ESOPHAGECTOMY: A MULTIDIMENSIONAL ANALYSIS

Diseases of the Esophagus ◽

10.1093/dote/doy089.ra03.07 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 24-24

Author(s):

Yin-Kai Chao

Keyword(s):

Esophageal Cancer ◽

Robotic Surgery ◽

Learning Curve ◽

Learning Curves ◽

Cancer Surgery ◽

Multidimensional Analysis ◽

Thoracoscopic Esophagectomy ◽

Video Assisted ◽

Esophageal Cancer Surgery ◽

Robotic Esophagectomy

Abstract Background Lymph node dissection (LND) along the left recurrent laryngeal nerve (RLN) is a technically challenging part of esophageal cancer surgery, especially after chemoradiotherapy (CRT). Robotic surgery holds promise to increase its safety and feasibility. Methods Patients who underwent minimally invasive esophagectomy and RLN dissection following CRT were dichotomized according to the use of robotic surgery (robotic esophagectomy [RE] versus video-assisted thoracoscopic esophagectomy [VATE]). Comparisons were made in terms of 1) number of dissected nodes, 2) rates of RLN palsy, 3) rates of perioperative complications, and 4) learning curves. Analysis of learning curves was performed with the cumulative sum (CUSUM) method (target failure rate for left RLN palsy: 15%). Results The RE and VATE groups consisted of 39 and 67 patients, respectively. The intraoperative identification of the left RLN was more common in the RE group (97.4%) than in the VATE group (68.7%, P < 0.001). Postoperative left RLN palsy was significantly more frequent in the VATE group (26.9%) than in the RE group (10.3%, P = 0.042), with a higher rate of pneumonia in the former (16.4% versus 2.6%, P = 0.03). CUSUM analysis revealed a longer learning curve when left RLN LND was performed through VATE. Left RLN palsy rates did not decrease below the target rate with the use of VATE, whereas RE allowed achieving the predefined target rate after 12 operations. Conclusion In the current study, we compared for the first time the learning curves of traditional and robotic surgery for RLN LND (which can be considered as one of the most technically challenging parts of esophageal cancer surgery). Our goal was to determine the minimum number of treated cases required to achieve an acceptable technical competency. Our data indicate that RE significantly facilitated a complex procedure like left RLN LND, resulting in a shorter learning curve compared with VATE. Notably, the left RLN was more easily identifiable with the use of RE, which in turn resulted in lower post-procedural left nerve palsy rates. Although MA analysis revealed that robotic surgery was initially more time-consuming than VATE, RE procedural times improved rapidly and became shorter than those of VATE after treatment of 26 cases. Disclosure All authors have declared no conflicts of interest.

Download Full-text

Computed Tomography-Based Evaluation of Volume and Position Changes of the Target Region and Organs at Risk During Radiotherapy for Esophageal Cancer: A Pilot Study

Frontiers in Oncology ◽

10.3389/fonc.2021.702400 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yi-mei Liu ◽

Ying-lin Peng ◽

Qi-wen Li ◽

Guanzhu Shen ◽

Ya-ru Ma ◽

...

Keyword(s):

Computed Tomography ◽

At Risk ◽

Esophageal Cancer ◽

Cancer Patients ◽

Organs At Risk ◽

Three Dimensional ◽

Intensity Modulated Radiation Therapy ◽

Conformal Radiotherapy ◽

Target Volume ◽

Target Volumes

ObjectiveTo analyze changes in volume and position of target regions and organs at risk (OARs) during radiotherapy for esophageal cancer patients.MethodsOverall, 16 esophageal cancer patients who underwent radiotherapy, including 10 cases of intensity-modulated radiation therapy (IMRT) and six of three-dimensional conformal radiotherapy (3D-CRT), were enrolled. The prescription doses for the planning target volumes (PTVs) were as follows: PTV1, 64 Gy/32 fractions; and PTV2, 46 Gy/23 fractions. Repeat computed tomography (CT) was performed for patients after the 5th, 10th, 15th, 20th, and 25th fractions. Delineation of the gross tumor volume (GTV) and OAR volume was determined using five repeat CTs performed by the same physician. The target and OAR volumes and centroid positions were recorded and used to analyze volume change ratio (VCR), center displacement (ΔD), and changes in the distance from the OAR centroid positions to the planned radiotherapy isocenter (distance to isocenter, DTI) during treatment.ResultsNo patient showed significant changes in target volume (TV) after the first week of radiotherapy (five fractions). However, TV gradually decreased over the following weeks, with the rate slowing after the fourth week (40 Gy). The comparison of TV from baseline to 40 Gy (20 fractions) showed that average GTVs decreased from 130.7 ± 63.1 cc to 92.1 ± 47.2 cc, with a VCR of −29.21 ± 13.96% (p<0.01), while the clinical target volume (CTV1) decreased from 276.7 ± 98.2 cc to 246.7 ± 87.2 cc, with a VCR of −10.34 ± 7.58% (p<0.01). As TVs decreased, ΔD increased and DTI decreased. After the fourth week of radiotherapy (40 Gy), centroids of GTV, CTV1, and prophylactic CTV (CTV2) showed average deviations in ΔD of 7.6 ± 4.0, 6.9 ± 3.4, and 6.0 ± 3.0 mm, respectively. The average DTI of the heart decreased by 4.53 mm (from 15.61 ± 2.96 cm to 15.16 ± 2.27 cm).ConclusionDuring radiotherapy for esophageal cancer, Targets and OARs change significantly in volume and position during the 2nd–4th weeks. Image-guidance and evaluation of dosimetric changes are recommended for these fractions of treatment to appropriate adjust treatment plans.

Download Full-text