152 SURGICAL PROCEDURE AND OUTCOME OF MEDIASTINOSCOPIC RADICAL ESOPHAGECTOMY FOR ESOPHAGOGASTRIC JUNCTION CANCER

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Atsushi Shiozaki ◽  
Hitoshi Fujiwara ◽  
Hirotaka Konishi ◽  
Michihiro Kudou ◽  
Hiroki Shimizu ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Single Port ◽  
Mediastinal Lymph Node ◽  
Mediastinal Lymph Node Dissection ◽  
Node Dissection ◽  
En Bloc ◽  
Radical Esophagectomy ◽  
Postoperative Respiratory Complications ◽  
Cervical Approach

Abstract   We started performing mediastinal lymph node dissection by a laparoscopic transhiatal approach (LTHA) in 2009. To date, 371 patients had undergone our method during various esophageal surgical procedures, including esophagogastric junction cancer (EGJC). Furthermore, we started performing single-port mediastinoscopic cervical approach in 2014, and developed a simple technique for transmediastinal radical esophagectomy (TMr) without thoracic approach (258 cases). Forty patients with EGJC were also treated by TMr. Methods Left single-port mediastinoscopic cervical approach was performed with pneumomediastinum. Mainly for advanced SCC, upper mediastinal lymph node dissection including recurrent laryngeal nerve LNs was performed with intraoperative monitoring using NIM system. Next, LTHA was performed for en bloc mediastinal lymph node dissection. The esophageal hiatus was opened, and working space was secured by Long Retractors. The posterior plane of the pericardium was extended. The posterior side of LNs was then separated. Finally, while lifting LNs like a membrane, they were resected from bilateral mediastinal pleura. Reconstruction with narrow gastric conduit was performed through substernal tract. Results Patients with EGJC performed TMr were analyzed (n = 40, SCC/Adeno/Others = 21/17/2). Upper mediastinal lymph node metastasis was found in 6 cases (SCC/Adeno = 3/3), middle mediastinal lymph node metastasis was found in 2 cases (SCC/Adeno = 1/1), and all of them had advanced tumors. Their perioperative outcome were compared with those performed the right thoracotomy (n = 41). The operative time and bleeding were decreased by TMr. The number of resected mediastinal lymph nodes, pR0 rate, and mediastinal recurrence in the two groups were not different. In 95.0% of patients treated by TMr, extubation was performed at 0 POD. Postoperative respiratory complications was decreased by TMr (TMr:7.5%, thoracotomy:17.1%). Conclusion This procedure, TMr, resulted in a good surgical view, safe en-bloc mediastinal lymph node dissection, and the decrease of postoperative respiratory complications in patients with EGJC.

PS02.002: EN-BLOC MEDIASTINAL LYMPH NODE DISSECTION USING A LAPAROSCOPIC TRANSHIATAL APPROACH FOR ESOPHAGEAL AND ESOPHAGOGASTRIC JUNCTION CANCERS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 120-120
Author(s):  
Atsushi Shiozaki ◽  
Hitoshi Fujiwara ◽  
Hirotaka Konishi ◽  
Katsutoshi Shoda ◽  
Tomohiro Arita ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Mediastinal Lymph Node ◽  
Mediastinal Lymph Node Dissection ◽  
Mediastinal Lymph Nodes ◽  
Node Dissection ◽  
En Bloc ◽  
Transhiatal Approach ◽  
Postoperative Respiratory Complications

Abstract Background The procedure for mediastinal lymph node dissection using a laparoscopic transhiatal approach (LTHA) had not been established for esophageal and esophagogastric junction (EGJ) cancers because of the difficulties associated with surgery. We developed a novel and simple technique for their en-bloc dissection using LTHA. To date, 296 patients had undergone our method during various esophageal surgical procedures, including 39 cases with EGJ cancer. We describe our technique and evaluate the optimal range of mediastinal lymph node dissection for EGJ cancer. Methods The esophageal hiatus was opened and CO2 was introduced into the mediastinum. The posterior plane of the pericardium was extended, and the anterior side of the subcarinal, main bronchial, thoracic paraaortic and pulmonary ligament lymph nodes were separated. The posterior side of these lymph nodes was then separated. Finally, while lifting lymph nodes like a membrane, they were resected from bilateral mediastinal pleura, main bronchi and tracheal bifurcation. Results 1) Patients with EGJ cancers performed middle and lower mediastinal lymph node dissection by LTHA (n = 39) were compared with those performed by the right thoracotomy (n = 41). The total operative time and bleeding were significantly decreased by LTHA. The number of resected middle and lower mediastinal lymph nodes, pR0 rate, and mediastinal recurrence in the two groups were not different. In 87.2% of patients treated by LTHA, extubation was performed at 0 POD. Postoperative respiratory complications was decreased by LTHA (LTHA: 7.7%, thoracotomy: 17.0%). 2) Patients with EGJ cancers performed total mediastinal lymph node dissection by thoracotomy for the time before introducing LTHA were analyzed (n = 37). Upper and/or middle mediastinal lymph nodes metastasis was observed in 10 cases, and all of them had advanced tumors. All of 6 cases with upper mediastinal lymph nodes metastasis were squamous cell carcinoma. Even in adenocarcinoma, middle mediastinal lymph node metastasis was observed in 2 cases, suggesting the importance of mediastinal lymph node dissection for advanced EGJ cancers. Conclusion Our surgical procedure resulted in a good surgical view, safe en-bloc mediastinal lymph node dissection, and the decrease of postoperative respiratory complications. Disclosure All authors have declared no conflicts of interest.

Video-assisted thoracoscopy the total mesoesophageal excision (TME) and systematic en bloc mediastinal lymph node dissection

ASVIDE ◽  
2016 ◽  
Vol 3 ◽  
pp. 229-229
Author(s):  
Mingqiang Kang ◽  
Shijie Huang ◽  
Jihong Lin ◽  
Shuchen Chen ◽  
Jiangbo Lin ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Mediastinal Lymph Node ◽  
Mediastinal Lymph Node Dissection ◽  
Node Dissection ◽  
En Bloc ◽  
Video Assisted

scholarly journals Advances and understanding pitfalls of laparoscopic transhiatal esophagectomy with en bloc mediastinal lymph node dissection

2020 ◽  
Vol 2020 ◽  
Author(s):  
Atsushi Shiozaki ◽  
Hitoshi Fujiwara ◽  
Hirotaka Konishi ◽  
Hiroki Shimizu ◽  
Michihiro Kudou ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Mediastinal Lymph Node ◽  
Transhiatal Esophagectomy ◽  
Mediastinal Lymph Node Dissection ◽  
Node Dissection ◽  
En Bloc

scholarly journals Endoscopic transesophageal mediastinal lymph node dissection and en bloc resection by using mediastinal and thoracic approaches (with video)

2010 ◽  
Vol 72 (4) ◽  
pp. 831-835 ◽  
Author(s):  
Brian G. Turner ◽  
Denise W. Gee ◽  
Sevdenur Cizginer ◽  
Min-Chan Kim ◽  
Mari Mino-Kenudson ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Mediastinal Lymph Node ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Mediastinal Lymph Node Dissection ◽  
Node Dissection ◽  
En Bloc

PS02.017: EFFICACY OF INTRAOPERATIVE RECURRENT LARYNGEAL NERVE MONITORING DURING UPPER MEDIASTINAL LYMPH NODE DISSECTION IN THORACOSCOPIC RADICAL ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 125-125
Author(s):  
Shigeru Lee ◽  
Yushi Fujiwara ◽  
Ryoya Hashiba ◽  
Ken Gyobu ◽  
Daiki Inazu ◽  
...  
Keyword(s):  
Lymph Node ◽  
Recurrent Laryngeal Nerve ◽  
Lymph Node Dissection ◽  
Tracheal Tube ◽  
Mediastinal Lymph Node ◽  
Laryngeal Nerve ◽  
Mediastinal Lymph Node Dissection ◽  
Node Dissection ◽  
Radical Esophagectomy ◽  
Nerve Monitoring

Abstract Background The development of minimally invasive surgery has yielded many benefits, therefore the number of patients undergoing thoracoscopic radical esophagectomy (TRE) for esophageal cancer has been increasing worldwide. However, in the Japanese nationwide web-based database report, the incidence of recurrent laryngeal nerve (RLN) paralysis and overall morbidity were significantly higher in the TRE group than in the open esophagectomy group. In recent years, intraoperative nerve monitoring (IONM) is commonly being used in thyroid and parathyroid surgery in many centers. We tried to determine the feasibility and effectiveness of IONM of RLN during upper mediastinal lymph node dissection in TRE. Methods All 628 patients who underwent TRE in the left lateral decubitus position at Osaka City University Hospital between May 1995 and February 2018 were enrolled in the present study. We introduced IONM using NIM® (Medtronic) during TRE from October 2016 at our hospital. We divided retrospectively the patients into two groups: IONM group (TRE with IONM of RLN; n = 49) and No-IONM group (TRE without IONM of RLN; n = 579). Diagnosis of RLN paralysis was performed using laryngoscopy. The feasibility of IONM during TRE and the incidence of postoperative RLN paralysis were compared with those in No-IONM group. Results IONM could be performed for 46 patients (93.9%) in IONM group. Three patients (6.1%) could not keep single-lung ventilation using a single lumen tracheal tube with a bronchial blocker and needed to replace a tracheal tube by a double lumen tube during TRE. The incidence of postoperative RLN paralysis (CD≧ 1; CD; Clavien-Dindo classification of surgical complications) was 17.4% in IONM group and 30.2% in No- IONM group. There was a significant difference in the incidence of postoperative RLN paralysis (P < 0.05). Moreover, the right and bilateral paralysis of RLN after TRE did not occur in any patients in IONM group. Conclusion IONM of RLN during TRE is technically feasible. The introduction of standardized IONM of RLN during TRE is able to reduce the incidence of postoperative RLN paralysis. Disclosure All authors have declared no conflicts of interest.

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