scholarly journals Lower local recurrence rate after robot-assisted thoracoscopic esophagectomy than conventional thoracoscopic surgery for esophageal cancer

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Satoru Motoyama ◽  
Yusuke Sato ◽  
Akiyuki Wakita ◽  
Yushi Nagaki ◽  
Hiromu Fujita ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Local Recurrence ◽  
Lymph Nodes ◽  
Thoracoscopic Surgery ◽  
Thoracoscopic Esophagectomy ◽  
Anastomotic Site ◽  
Recurrent Nerve ◽  
Robot Assisted ◽  
Paraaortic Lymph Nodes ◽  
Surgical Field

AbstractThe oncological advantages of robot-assisted thoracoscopic esophagectomy (RATE) over conventional thoracoscopic esophagectomy (TE) for thoracic esophageal cancer have yet to be verified. In this study, we retrospectively analyzed clinical data to compare the incidences of recurrence within the surgical field after RATE and TE as an indicator of local oncological control. Among 121 consecutive patients with thoracic esophageal or esophagogastric junction cancers for which thoracoscopic surgery was indicated, 51 were treated with RATE while 70 received TE. The number of lymph nodes dissected from the mediastinum, duration of the thoracic portion of the surgery, and morbidity due to postoperative complications did not differ between the two groups. However, the rate of overall local recurrence within the surgical field was significantly (P = 0.039) higher in the TE (9%) than the RATE (0%) group. Lymph node recurrence within the surgical field occurred in left recurrent nerve, left tracheobronchial, left main bronchus and thoracic paraaortic lymph nodes, which were all difficult to approach to dissect. The other two local failures occurred around the anastomotic site. This study indicates that using RATE enabled the incidence of recurrence within the surgical field to be reduced, though there were some limitations.

VS01.04: RELIABLE SURGICAL TECHNIQUES FOR LYMPHADENECTOMY ALONG THE LEFT RECURRENT LARYNGEAL NERVE DURING THORACOSCOPIC ESOPHAGECTOMY IN THE PRONE POSITION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 44-44
Author(s):  
Taro Oshikiri ◽  
Tetsu Nakamura ◽  
Hiroshi Hasegawa ◽  
Masashi Yamamoto ◽  
Shingo Kanaji ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Recurrent Laryngeal Nerve ◽  
Prone Position ◽  
Conflicts Of Interest ◽  
Surgical Techniques ◽  
Laryngeal Nerve ◽  
Thoracoscopic Esophagectomy ◽  
Left Recurrent Laryngeal Nerve

Abstract Description Background Lymphadenectomy along the left recurrent laryngeal nerve (RLN) in esophageal cancer is important for disease control but requires advanced dissection skills. Complete dissection of the lymph nodes along the left RLN in a safe manner is important. We demonstrate the reliable method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the prone position (TEP). Methods This procedure is performed for all of resectable thoracic esophageal cancers. The essence of this method is to recognize the lateral pedicle as a two-dimensional membrane that inclu replicatedes the left RLN, lymph nodes around the nerve, and primary esophageal arteries. By drawing the proximal portion of the divided esophagus and the lateral pedicle, identification and reliable cutting of the primary esophageal arteries and distinguishing the left RLN from the lymph nodes are simplified. Results We performed 46 TEPs for esophageal cancer using this method with no conversion to an open procedure in 2015 at Kobe University. No intraoperative morbidity related to the left RLN was observed. The mean number of harvested lymph nodes along the left RLN was 6.9 ± 4.2. Left RLN palsy greater than Clavien-Dindo classification grade II occurred in 4 patients (8%), all of them were reversible. The incidence of lymph node metastasis along the left RLN was 22%. Conclusion Our method for lymphadenectomy along the left RLN during TEP is safe and reliable. It has a low incidence of left RLN palsy and provides sufficient lymph node dissection along the left RLN. Disclosure All authors have declared no conflicts of interest.

PS01.235: THE METHOD AND THE SHORT OUTCOME OF MEDIASTINAL LYMPH NODES DISSECTION FOR ESOPHAGEAL CANCER USING A TRANS-BICERVICAL AND TRANSHIATAL APPROACH UNDER THE PNEUMOMEDIASTINUM

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 116-116
Author(s):  
Yutaka Tokairin ◽  
Yasuaki Nakajima ◽  
Kenro Kawada ◽  
Akihiro Hoshino ◽  
Takuya Okada ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Recurrent Nerve ◽  
Node Dissection ◽  
Radical Esophagectomy ◽  
Transhiatal Approach ◽  
Cervical Approach ◽  
Thoracic Approach ◽  
The Right

Abstract Background We previously reported the performance of mediastinoscopic esophagectomy with lymph node dissection (MELD) under pneumomediastinum using a transcervical and transhiatal approach as a method of radical esophagectomy. For more complete lymph node dissection, it is necessary to dissect via not only left cervical but also right cervical approach in pneumomediastinum. We herein report the dissection method for upper mediastinum using a cervico-pneumomediastinal approach including right cervical approach in pneumomediastinum and the short surgical outcome. Methods This method was applied to nine cases for esophageal cancer. The right recurrent nerve was first identified using an open approach. Pneumomediastinum was then initiated to allow for the 105 and 106recR lymph nodes to be completely dissected along the right mediastinal pleura, the right vagus nerve, the proximal portion of the azygos vein and the right bronchial artery. The left recurrent nerve (106recL) lymph nodes and 106tbL lymph nodes were dissected using a cross-over technique, as described previously. Results This operation using bilateral cervical approach in pneumomediastinum were performed for nine cases. The median operation time and bleeding is 606 minutes and 506 ml, respectively. The median post-operative stay is 15 days. Conclusion MELD is therefore considered to be a more minimally invasive and useful modality for radical esophagectomy than the thoracic approach, although the field of view is different from that of the thoracic approach. Disclosure All authors have declared no conflicts of interest.

Transcervical Dissection of the Recurrent Nerve Lymph Nodes for Patients with Esophageal Cancer

2009 ◽  
Vol 60 (2) ◽  
pp. 131-132
Author(s):  
M. Watanabe ◽  
R. Karashima ◽  
N. Sato ◽  
K. Hirashima ◽  
Y. Hiyoshi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Nodes ◽  
Recurrent Nerve

scholarly journals Robot-assisted esophageal surgery using the da Vinci® Xi system for Benign and malignant diseases of esophagus：Preliminary experience of robot assisted modified Sweet operation

2020 ◽  
Author(s):  
Bei Lu ◽  
Li xin Sun ◽  
Zhonghao Wang ◽  
Xi Yan ◽  
Zhenzhong Ai ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Thoracoscopic Surgery ◽  
Esophageal Surgery ◽  
Thoracic Cavity ◽  
Malignant Diseases ◽  
Robot Assisted ◽  
Esophageal Diseases ◽  
Benign Diseases ◽  
Robotic Assisted ◽  
The Right

Abstract Background Since our hospital installed the DaVinci ® Xi system, we have performed 60 thoracic surgeries in four months. As 25 of these 60 patients contain various types of esophageal benign and malignant diseases, we have no time to summarize our work after understanding and learning the experience of previous experts, so as to share our preliminary experience in using DaVinci ® Xi system in esophageal surgery. Because robot surgery system is the most effective for small and hard to reach areas, we have made many attempts in benign esophageal diseases. Compared with DaVinci ® Si, DaVinci ® Xi has many new functions, so we explore new surgical methods for some special esophageal cancer cases, such as the robot assisted modified Sweet operation.Methods Using DaVinci® Xi system(Intuitive Surgical, China), we performed robotic assisted thoracoscopic surgery (RATS) on 15 patients with esophageal cancer and 10 patients with various types of esophageal benign diseases. Among all esophageal cancer patients, 6 patients with lower esophageal cancer underwent resection of left thoracic esophageal cancer and lymphadenectomy, then diaphragm was cut, stomach was separated from abdominal cavity and lymphadenectomy was performed. Finally, 5 cases were anastomosed with stomach and esophagus under the aortic arch, and 1 case was anastomosed with stomach and esophagus in the neck combined with mediastinoscopic neck lymphadenectomy. McKeown was performed in 3 of the other 9 cases. Six patients underwent the Ivor Lewis operation, one of them was converted to the left thoracogastrostomy because of the extensive adhesion of the right thoracic cavity. Other benign diseases included esophageal leiomyomectomy in 3 cases, esophageal diverticulum in 1 case, hiatal hernia in 4 cases, esophageal cyst in 1 case, achalasia in 1 case. Results All the procedures were successfully completed by robot except one patient with extensive adhesion of right thoracic cavity and only abdominal operation. The median operation time of esophageal cancer patients was 286（240-348 minutes,There were no complications during operation. One patient had a neck anastomotic leakage and the wound healed after local washing for 3 weeks. Because of the short time of observation, there is no death of malignant tumor and no serious complication of benign disease. Conclusions Through the experience of such a small series of robotic assisted thoracoscopic surgery for various esophageal diseases, we support the impression that: 1. The esophagus is an ideal organ for robotic surgery, which is a good indication for malignant tumor surgery; 2. Under the vision of the robot, each layer of esophageal mucosa can be seen clearly, which is very conducive to the resection of small leiomyoma or cyst In addition, 3. Flexible arms can be used for various anastomosis or suture operations. 4. Through the left thorax and diaphragm incision can be used as a "robot" Sweet operation for the right patient, with mediastinoscopy to clean up the upper mediastinal lymph nodes can achieve better results.

scholarly journals Thoracoscopic esophagectomy in the prone position for esophageal cancer patients with pectus excavatum: a report of two cases

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Tomoya Tsukada ◽  
Yuto Kitano ◽  
Yuya Sugimoto ◽  
Masahide Kaji
Keyword(s):  
Computed Tomography ◽  
Esophageal Cancer ◽  
Prone Position ◽  
Pectus Excavatum ◽  
Thoracoscopic Esophagectomy ◽  
Field Of View ◽  
Case Presentation ◽  
Haller Index ◽  
Surgical Field ◽  
Surgical Option

Abstract Background Pectus excavatum is a common thoracic deformity that can be encountered during thoracoscopic esophagectomy. Here, we report two cases of esophageal cancer complicated by pectus excavatum that were treated with thoracoscopic esophagectomy with the patients in the prone position. Case presentation The first patient was a 64-year-old male diagnosed with esophageal cancer (cT3N0M0, Haller index 8.5) and underwent radical thoracoscopic esophagectomy in the prone position following neoadjuvant chemotherapy. The second patient was a 67-year-old male diagnosed with esophageal cancer (cT1bN0M0, Haller index 4.3), and the same procedure was performed in this patient. In cases of patients with a high Haller index, where securing the surgical field is difficult, preoperative computed tomography in the prone position can help surgeons to understand the mediastinal field of view and is safe. Conclusions Radical thoracoscopic esophagectomy in the prone position may be a surgical option in patients with pectus excavatum.

FA01.05: EARLY RESULTS OF ROBOT ASSISTED ESOPHAGECTOMY COMPARED WITH CONVENTIONAL THORACOSCOPIC APPROACH FOR ESOPHAGEAL CANCER: A RANDOMIZED CLINICAL TRIAL

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 2-2
Author(s):  
Bin Li ◽  
Zhigang Li
Keyword(s):  
Esophageal Cancer ◽  
Lymph Nodes ◽  
Clinical Characteristics ◽  
Operation Time ◽  
Perioperative Outcomes ◽  
Robot Assisted ◽  
Term Survival ◽  
Thoracoscopic Approach ◽  
Early Results ◽  
Laparoscopic Esophagectomy

Abstract Background Minimally invasive esophagectomy (MIE) has become increasingly adopted as a standard surgical approach for esophageal cancer because of less tissue damage and a more rapid recovery. Recent developments in robotic technology have made robot-assisted minimally esophagectomy as another surgical option for MIE. The aim of the study was to compare early results between robot-assisted thoraco-laparoscopic esophagectomy (RATLE) and conventional thoraco-laparoscopic esophagectomy(CTLE) for the treatment of esophageal squamous cell carcinoma (ESCC). Methods We designed a randomized controlled parallel-group trial study. Patients aged 18–75 years with histologically proven surgically resectable (cT1b-3, N0–2, M0) ESCC of the intrathoracic esophagus were randomly assigned to receive either RATLE or CTLE. All patients received McKeown esophagectomy. Clinical characteristics and perioperative outcomes between the two groups were compared. Results Seventy patients were randomly assigned to RATLE group(n = 36) and CTLE group(n = 34). The two groups were comparable in preoperative clinical characteristics. Patients who underwent RATLE had shorter total operation time than the CTLE group (217.3 ± ± 44.5 vs. 261.5 ± 62.1 minutes, P = 0.001), particularly in thoracoscopic time (74.0 ± 23.6 vs. 104.1 ± 34.2 minutes, P < 0.001). The incidence of recurrent laryngeal palsy is higher in RATLE group(25%) than CTLE group(11.8%), but it was not statistically significant (P = 0.155). Intraoperative blood loss, length of hospital stay and the incidence of postoperative complications were not statistically different between the two groups. Four (11.1%) patients have anastomotic leakage in the RATLE group, compared to 4 (11.8%) patients in the CTLE group (P = 0.772). The RATLE and CTLE groups did not differ significantly with regard to the total number of harvested lymph nodes (18.8 ± 7.0 vs. 20.1 ± 8.3, P = 0.468), the numbers of lymph nodes dissected from recurrent laryngeal nerve chains(4.7 ± 3.1 vs. 4.9 ± 3.4, P = 0.779) and the abdomen(5.9 ± 3.5 vs. 5.1 ± 3.1, P = 0.354). Conclusion There is technical superiority with shorter operation time and similar short-term surgical results for RATLE compared with CTLE. Though the incidence of postoperative recurrent laryngeal palsy is slightly higher for RATLE, it doesn’t affect postoperative recovery. Long-term survival data should be followed in the future to compare the oncological outcome between the two groups. Disclosure All authors have declared no conflicts of interest.

scholarly journals Esophageal cancer with right vertebral artery variation observed during thoracoscopic esophagectomy: a case report

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuta Sato ◽  
Yoshihiro Tanaka ◽  
Takeharu Imai ◽  
Yuji Hatanaka ◽  
Naoki Okumura ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Blood Vessel ◽  
Vertebral Artery ◽  
Subclavian Artery ◽  
Anatomical Variation ◽  
Laryngeal Nerve ◽  
Thoracoscopic Esophagectomy ◽  
Case Presentation ◽  
Surgical Field ◽  
The Right

Abstract Background Variation of the vertebral artery bifurcation is rare. This branching abnormality can cause unexpected vertebral artery damage and bleeding during thoracoscopic esophagectomy. There are few reports of abnormal branching of the vertebral artery associated with neurosurgery but none related to esophagectomy. We report the case together with the results of the evaluation of vertebral artery bifurcation and length in 50 patients with esophageal cancer in our hospital. Case presentation Thoracoscopic esophagectomy was performed on a 70-year-old patient with esophageal cancer. During lymph node dissection around the right reccurent laryngeal nerve, an unusual blood vessel was found running along the right subclavian artery. We determined this blood vessel to be the right vertebral artery branching far more centrally than usual. Because this anatomical abnormality was clarified, we could then recognize that the right reccurent laryngeal nerve coursed around the right vertebral artery and the right subclavian artery and thus was running in a larger arch than usual. Conclusion Long right vertebral artery may appear in the surgical field of the thoracoscopic esophagectomy. Knowledge of such anatomical variation is important to prevent iatrogenic injury of the right vertebral artery and the right reccurent laryngeal nerve.

PS02.005: THORACOSCOPIC ESOPHAGECTOMY IN PRONE POSITION USING A PRECEDING ANTERIOR APPROACH FOR ESOPHAGEAL CANCER: LONG-TERM AND SHORT-TERM OUTCOMES

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 121-121
Author(s):  
Soji Ozawa ◽  
Junya Oguma ◽  
Akihito Kazuno ◽  
Miho Yamamoto ◽  
Yamato Nimomiya ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Nodes ◽  
Anterior Approach ◽  
Thoracoscopic Esophagectomy ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Thoracoscopic Procedure ◽  
Better Than

Abstract Background The purpose of this study was to clarify the long-term and short-term outcomes of consecutive patients who underwent thoracoscopic esophagectomy in prone position using a preceding anterior approach for the resection of esophageal cancer at a single institution. Methods We retrospectively reviewed a database of 690 patients with thoracic esophageal cancer who had undergone a thoracoscopic esophagectomy (TE, 351 patients) or an esophagectomy through thoracotomy (OE, 343 patients) between 2003 and 2017. To compare the long-term outcomes of TE and OE, we used a propensity score matching analysis and a Kaplan-Meier survival analysis. To analyze the short-term outcomes of TE, patients were chronologically divided into three groups (117 patients per group). As for thoracoscopic procedure, the esophagus was mobilized from the anterior structure during the first step and from the posterior structure during the second step. The lymph nodes around the esophagus were also dissected anteriorly and posteriorly. The intraoperative factors, the number of dissected lymph nodes, and the incidence of adverse events were compared among the three period groups. Results As for long term outcome, 203 patients from each group, for a total of 406 patients, were completely selected and paired. The 5-year survival of the TE patients (66.8%) was better than that of the OE patients (56.4%) (P = 0.044). The thoracoscopic times were 226 min, 241 min, and 214 min (P < 0.001), and the blood losses during the thoracoscopic procedure were 36.1 mL, 43.3 mL, and 18.0 mL (P < 0.001), respectively, according to the period groups. The mean numbers of harvested lymph nodes in the chest were 22.2, 25.1, and 28.9 (P < 0.001). The rates of recurrent laryngeal nerve palsy were 23.9%, 29.9%, and 8.6% (P < 0.001). Conclusion The long-term outcome of TE patients might be better than that of OE patients. As for the short-term outcomes, intraoperative factors, quality of lymph node dissection, and reduction of adverse events were best in the third period group. Establishment of standard procedure and accumulation of surgical cases seemed to make TE a safe and effective procedure for esophageal cancer. Disclosure All authors have declared no conflicts of interest.

scholarly journals Salvage Robotic-Assisted Thoracoscopic Esophagectomy after Definitive Chemoradiotherapy for Clinical T4b Esophageal Cancer: A Case Report

2021 ◽  
Author(s):  
Ryohei Sasamori ◽  
Satoru Motoyama ◽  
Yusuke Sato ◽  
Akiyuki Wakita ◽  
Yushi Nagaki ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Main Bronchus ◽  
Left Main Bronchus ◽  
Thoracoscopic Esophagectomy ◽  
Left Main ◽  
Robot Assisted ◽  
Definitive Chemoradiotherapy ◽  
Thoracic Esophageal Cancer ◽  
Robotic Assisted ◽  
Salvage Esophagectomy

Abstract BackgroundAlthough twenty years have passed since the start of robot-assisted thoracoscopic esophagectomy, salvage esophagectomy by robotic-assisted surgery has not yet been introduced by almost surgeons. Theoretically, robot-assisted thoracoscopic esophagectomy (RATE) increases operative precision and maneuverability within the narrow space of the mediastinum. However, surgeons have doubted that RATE is indicated for patients with tumor invasion of adjacent vital organs clinically (cT4b) or patients with scar tissue from definitive chemoradiotherapy. Herein, we report our case of salvage RATE for cT4b thoracic esophageal cancer which invaded to the left main bronchus before definitive chemoradiotherapy.Case presentationA man in his 60’s with middle thoracic esophageal cancer [cT4b (left main bronchus) N1 M0 cStage IIIC] received definitive chemoradiotherapy (fluorouracil and cisplatin, total radiation dose of 60 Gy). After the chemoradiotherapy, upper gastrointestinal endoscopy revealed a residual primary tumor, and we performed robotic-assisted thoracoscopic subtotal esophagectomy and gastric tube reconstruction via a retrosternal route with three-field lymphadenectomy. Although it was difficult to dissect the tumor from adjacent organs, especially in the left main bronchus and pericardium, due to the scarring after definitive chemoradiotherapy, R0 surgery was achieved. With RATE, the high-resolution three-dimensional images, stable surgical field and stable motion are considerable advantages for salvage esophagectomy for cT4b tumors. At present (30 months after surgery), the patient’s performance status is 0 and he is alive without a recurrence. ConclusionsRobot-assisted thoracoscopic esophagectomy provided considerable advantages for salvage esophagectomy after definitive chemoradiotherapy for a cT4b tumor.

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