PS01.191: LAPAROSCOPIC TRANSHIATAL LOWER MEDIASTINAL LYMPHADENECTOMY FOR ESOPHAGOGASTRIC JUNCTIONAL CANCER: THE INFRACARDIAC BURSA AS A LANDMARK

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 104-104
Author(s):  
Yasunori Kurahashi ◽  
Tatsuro Nakamura ◽  
Rie Ozawa ◽  
Yasutaka Nakanishi ◽  
Hirotaka Niwa ◽  
...  
Keyword(s):  
Lymph Node ◽  
Esophagogastric Junction ◽  
Conflicts Of Interest ◽  
Ventral Side ◽  
Dorsal Side ◽  
Node Dissection ◽  
Mediastinal Lymphadenectomy ◽  
Operating Field ◽  
Esophagogastric Junction Cancer ◽  
The Right

Abstract Background Esophagogastric junction cancer has been increasing recently. As a result, opportunities to perform transhiatal lower mediastinal lymphadenectomy are also increasing. Laparoscopic surgery is useful because the operating field of this site is too deep and narrow to perform laparotomy. But the anatomy of this area is not sufficiently clarified, and since there are few structures as landmarks, it is difficult to set the range and depth of lymph node dissection. Methods We have been verifying anatomically and embryologically the infracardiac bursa (ICB) identified as a closed lumen between the esophagus and the right crus of the diaphragm during an operation. We standardized the procedure of transhiatal lower mediastinal lymphadenectomy setting several landmarks including ICB. Results In transhiatal lower mediastinal lymphadenectomy, it is possible to do a precise lymphadenectomy by setting several landmarks including the ICB and standardizing each procedure on the ventral side, dorsal side, and both sides of the esophagus. In the case of advanced cancer which invades organs around the hiatus, it is difficult to perform routine dissection by using the infracardiac bursa or the dissectable layer. Understanding of the anatomy of this area will support the safe and precise lymphadenectomy. Conclusion In this presentation, we will show the procedure of transhiatal lower mediastinal lymphadenectomy using the ICB as a landmark. Disclosure All authors have declared no conflicts of interest.

VS01.06: THORACOSCOPIC EXTENDED LYMPHADENECTOMY FOR EGJ CANCER: AN OPTION TO LEARN FROM THE EAST

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 45-45
Author(s):  
Simone Giacopuzzi ◽  
Jacopo Weindelmayer ◽  
Giovanni De Manzoni
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Recurrent Laryngeal Nerve ◽  
Esophagogastric Junction ◽  
Conflicts Of Interest ◽  
Laryngeal Nerve ◽  
Extended Lymphadenectomy ◽  
Node Dissection ◽  
Node Metastasis ◽  
The Right

Abstract Description Extended thoracoscopic lymphadenectomy is not common practice in Western countries in patients with adenocarcinoma of the esophagogastric junction. In this video we present a case of a patient with siewert I adenocarcinoma with lymph node metastasis to the right recurrent laryngeal nerve not treated with neoadjuvant therapy, due to comorbidity. The operation was: extended thoracoscopic en-block lymph node dissection. video will be edited in a more rigorous manner Disclosure All authors have declared no conflicts of interest.

55 OPTIMAL LYMPH NODE DISSECTION RANGE FOR ESOPHAGOGASTRIC JUNCTION CANCER

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
H Okamoto ◽  
Y Taniyama ◽  
C Sato ◽  
K Takaya ◽  
T Fukutomi ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Esophagogastric Junction ◽  
Mediastinal Lymph Node ◽  
Multidisciplinary Treatment ◽  
R0 Resection ◽  
Preoperative Treatment ◽  
Node Dissection ◽  
Subtotal Esophagectomy ◽  
Esophagogastric Junction Cancer

Abstract   There is no consensus on the mediastinal lymph node dissection range for esophagogastric junction cancer (EGJC). Methods We enrolled 113 patients with EGJC (defined by Nishi’s classification) who underwent R0 resection between January 2001 and December 2016, focusing on comparisons between squamous cell carcinoma (SCC) and adenocarcinoma (AC). Results The characteristics of patients with SCC (n = 53) and AC (n = 55) were as follows: age: 65.4 ± 1.4 and 64.1 ± 1.5 years; male/female: 46/12 and 48/7; preoperative treatment (none/NAC/NACRT): 29/19/10 and 53/2/0; surgical method (subtotal esophagectomy/lower esophagectomy and gastrectomy): 39/19 and 34/21; pStage (I/II/III): 15/14/29 and 13/10/32, respectively. Esophageal invasion (EI) exceeding 20 mm was associated with an increased incidence of metastasis to the upper and middle mediastinal LN in patients with SCC and AC. However, for patients with SCC, the upper/middle mediastinal LN dissection effect index was 6.9/6.9 compared with 0/0 for AC patients. Conclusion In patients with EI exceeding 20 mm, esophagectomy with lymphadenectomy up to the upper mediastinum should be performed owing to the high incidence of upper and middle mediastinal LNM. However, the dissection effect is very poor in patients with AC; therefore, multidisciplinary treatment should be considered for these patients.

RA01.05: MINIMALLY INVASIVE ESOPHAGECTOMY AND 3-FIELD LYMPH NODE DISSECTION (ESOPHAGEAL SUSPENSION METHOD)—FUJIAN MEDICAL UNIVERSITY UNION HOSPITAL EXPERIENCE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 18-19
Author(s):  
Bin Zheng ◽  
Shuliang Zhang ◽  
Taidui Zeng ◽  
Wei Zheng ◽  
Chun Chen
Keyword(s):  
Lymph Node ◽  
Minimally Invasive ◽  
Lymph Node Dissection ◽  
Conflicts Of Interest ◽  
Thoracic Esophagus ◽  
Node Dissection ◽  
Radical Lymph Node Dissection ◽  
Extensive Lymphadenectomy ◽  
Radical Lymph Node ◽  
The Right

Abstract Description We have modified our procedures of lymphadenectomy, with the purpose of radical lymph node dissection, because we believe that radical lymph node dissection along bilateral RLNs may be crucial for post-operative accurate staging, local control and better prognosis. Programmed lymphadenectomy includes several steps. Programmed extensive lymphadenectomy along right RLN included 3 steps: (1) Location of the right vagus nerve. (2) Loaction of the root of the right RLN. (3) Extensive lymphadenectomy. Programmed extensive lymphadenectomy along left RLN was conducted subsequently, which included 4 steps. (1) Esophageal suspension. (2) Lymph node rolling.(3) Location and identification of left RLN. (4) Extensive lymphadenectomy. During the whole procedure, we preferred to use blunt separation in the zones near the RLN, and preferred to use the ultrasound knife and scissors rather than electrical knife. The thoracic esophagus was not cut off during the procedure. After the thoracic procedures, we do the laparoscopic gastric dissociation and lymph node dissection. When metastasis to either RLN chains was confirmed by routine intra-operative frozen section, bilateral cervical lymphadenectomy was also performed. We divided the procedures into steps, which could have following advantages: more radical lymph node clearance with skeletonization of the nerves, reduced injuries due to definite location and identification of the nerves, more easier for surgeons to expose the surgical field and more easier for new-hands to master the procedures. Minimally invasive esophageactomy and thoracoscopic programmed extensive lymphadenectomy along the left and right RLNs in esophagectomy was feasible and safe. According to our study, programmed extensive lymphadenectomy yielded sufficient lymph nodes, with acceptable postoperative complications. Disclosure All authors have declared no conflicts of interest.

VS01.08: STEPWISE APPROACH FOR ROBOT-ASSISTED THORACOSCOPIC LEFT RECURRENT LARYNGEAL NERVE LYMPH NODE DISSECTION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 45-45
Author(s):  
Yin-Kai Chao
Keyword(s):  
Lymph Node ◽  
Recurrent Laryngeal Nerve ◽  
Lymph Node Dissection ◽  
Dorsal Side ◽  
Laryngeal Nerve ◽  
Node Dissection ◽  
Robot Assisted ◽  
Stepwise Approach ◽  
Left Recurrent Laryngeal Nerve ◽  
The Right

Abstract Description This video showed the stepwise approach for robot-assisted thoracoscopic left recurrent laryngeal nerve lymph node dissection. With the patient lying in the left semiprone position, a total of five trocars were positioned. Left RLN LND was begun by releasing the right esophagotracheal band. Subsequently, the trachea was gradually rotated clockwise through the application of a gentle pressure on the left edge of the tracheal cartilage with the goal of exposing and releasing the left esophagotracheal band. After the complete release of the bilateral esophagotracheal band, the esophagus was retracted toward the dorsal side with the right first robotic arm. Simultaneously, an assistant rolled back the trachea using a forceps grasping a small piece of gauze, with the aim of improving operative exposure. The left RLN was identified in the middle of the soft tissue between the trachea and the esophagus. Dissection was started from the ventral side RLN nodes and subsequently continued toward the dorsal side until the total skeletonization of the left RLN Disclosure All authors have declared no conflicts of interest.

scholarly journals Chyle Leak after Right Axillary Lymph Node Dissection in a Patient with Breast Cancer

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Ankita Sarawagi ◽  
Jessica Maxwell
Keyword(s):  
Lymph Node ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Ductal Carcinoma ◽  
Tissue Expander ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Chyle Leak ◽  
The Right

Background. A female patient was diagnosed with a right-sided chyle leak following right skin sparing mastectomy, axillary lymph node dissection, and immediate tissue expander placement in the setting of invasive ductal carcinoma status post neoadjuvant chemotherapy. Summary. Our patient underwent a level I and II right axillary lymph node dissection followed by an axillary drain placement. On the first postoperative day, a change from serosanguinous to milky fluid in this drain was noted. The patient was diagnosed with a chyle leak based on the milky appearance and elevated triglyceride levels in the fluid. While chyle leaks are rare after an axillary dissection and even rarer to present on the right side, it is a complication of which breast surgeons should be aware. The cause of this complication is thought to be due to injury of the main thoracic duct, its branches, the subclavian duct, or its tributaries. Management is usually conservative; however, awareness of this potential complication even on the right side is of the utmost importance Conclusion. Chyle leaks are an uncommon complication of axillary node dissections and even rarer for them to present on the right side. It can be diagnosed by monitoring the drainage for changes in appearance and volume and by conducting supporting laboratory tests. Conservative management is generally suggested.

PS01.031: REVISITING THE ESOPHAGOGASTRIC JUNCTION ANATOMY: WHERE IS THE INFRACARDIAC BURSA?

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 58-59
Author(s):  
Tatsuro Nakamura ◽  
Hisashi Shinohara ◽  
Tomoaki Okada ◽  
Shigeo Hisamori ◽  
Shigeru Tsunoda ◽  
...  
Keyword(s):  
Esophagogastric Junction ◽  
Conflicts Of Interest ◽  
Three Dimensional ◽  
Human Embryos ◽  
Closed Space ◽  
Mr Images ◽  
Crown Rump Length ◽  
Transhiatal Approach ◽  
Dimensional Reconstruction ◽  
The Right

Abstract Background The infracardiac bursa (ICB), the closed space encountered in the esophagogastric junction (EGJ) surgery, is rarely described in anatomical atlases. The purpose of the study is to link surgery to embryology and propose the new anatomical chart including the ICB. Methods Histological serial sections of Carnegie stages (CS) 13–23 embryos and magnetic resonance (MR) images of the fetus with 43.5 mm crown-rump length from the Kyoto Collection of Human Embryos were examined for embryological changes in the ICB. Seventy-four surgery videos of laparoscopic and thoracoscopic esophagectomy were reviewed to investigate the appearance of the ICB and frequency of the recognition in surgery. Results The right pneumato-enteric recess appeared in CS13 embryos and the ICB was separated from the recess by the development of the diaphragm between CS17 and CS18 embryos and established as a closed space up until CS23. The three-dimensional reconstruction of fetus MR images showed the ICB was located adjacent nearly one third around the esophagus above the right crus. The ICB was clinically encountered in 12 of 14 (86%) transhiatal surgeries and 23 of 60 (38%) thoracic surgeries. Via the transhiatal approach, the caudal edge of the ICB appeared as a thick whitish membrane after the dissection of the phrenico-esophageal ligament and a closed space enveloped with a serosa was opened by the incision of the membrane. Via the right thoracic approach, the ICB appeared on the right crus after the dissection of the pulmonary ligament. Conclusion We described a new chart around EGJ including the ICB based on embryology. This anatomical chart can contribute to promote accuracy and safety of operating procedures around the EGJ. Disclosure All authors have declared no conflicts of interest.

scholarly journals Recurrent laryngeal nerve monitoring during totally robot-assisted Ivor Lewis esophagectomy

2020 ◽  
Vol 405 (8) ◽  
pp. 1091-1099
Author(s):  
J. I. Staubitz ◽  
P. C. van der Sluis ◽  
F. Berlth ◽  
F. Watzka ◽  
F. Dette ◽  
...  
Keyword(s):  
Lymph Node ◽  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Node Dissection ◽  
Robot Assisted ◽  
Nerve Monitoring ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Vocal Cord Paresis ◽  
The Right

Abstract Purpose The robot-assisted approach for Ivor Lewis esophagectomy offers an enlarged, three-dimensional overview of the intraoperative situs. The vagal nerve (VN) can easily be detected, preserved, and intentionally resected below the separation point of the recurrent laryngeal nerve (RLN). However, postoperative vocal cord paresis can result from vagal or RLN injury during radical lymph node dissection, presenting a challenge to the operating surgeon. Methods From May to August 2019, 10 cases of robot-assisted minimally invasive esophagectomy (RAMIE) with extended 2-field lymphadenectomy, performed at the University Medical Center Mainz, were included in a prospective cohort study. Bilateral intermittent intraoperative nerve monitoring (IONM) of the RLN and VN was performed, including pre- and postoperative laryngoscopy assessment. Results Reliable mean signals of the right VN (2.57 mV/4.50 ms) and the RLN (left 1.24 mV/3.71 ms, right 0.85 mV/3.56 ms) were obtained. IONM facilitated the identification of the exact height of separation of the right RLN from the VN. There were no cases of permanent postoperative vocal paresis. Median lymph node count from the paratracheal stations was 5 lymph nodes. Conclusion IONM was feasible during RAMIE. The intraoperative identification of the RLN location contributed to the accuracy of lymph node dissection of the paratracheal lymph node stations. RLN damage and subsequent postoperative vocal cord paresis can potentially be prevented by IONM.

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