PS02.003: SINGLE INCISION TRANSCERVICAL MEDIASTINOSCOPIC LYMPHADENECTOMY FOR ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 120-120
Author(s):  
Chang Hyun Kim ◽  
Jin-Jo Kim
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Old Age ◽  
Single Incision ◽  
Conflicts Of Interest ◽  
Mediastinal Lymph Node ◽  
Safe Procedure ◽  
En Bloc ◽  
Transhiatal Approach ◽  
The Mean

Abstract Background A transhiatal approach in esophageal cancer surgery has limitation for mediastinal lymph node dissection compared with thransthoracic approach for esophageal cancer. Because of insufficient lymph node clearance, single incision mediastinoscopic surgery is an one of the minimally invasive surgical option for esophageal cancer. Herein, we introduce our initial experience with use of the procedure in 3 patients with esophageal cancer Methods We retrospectively collected data from 3 patients who diagnosed with esophageal cancer and who underwent 3 field transmediastinal radical esophagectomy (TMRE) between Jun 2016 and December 2017. TMRE was performed in old age patients (> 75 years) and patients with limited cardiopulmonary reserve in whom thransthoracic approach could not be used. After the left cervical incision and cervical lymphadenectomy, a single port was inserted into the wound. Esophageal mobilization with en bloc lymphadenectomy along the left and right recurrent laryngeal nerve was then performed. Carbon dioxide insufflation expanded the intramediastinal space, and deep mediastinal structures were clearly visualized, allowing lymphadenectomy to be safely and carefully performed along the nerves. Laparoscopic transhiatal esophagectomy was then performed with en bloc lymphadenectomy for lower and/or middle mediastinal nodes. Results The mean age was 75.5 ± 3.5. Among the 3 patients, two patients had severe cardiopulmonary dysfunction. The mean operation time in transmediastinal approach and transhiatal approach were 202.0 ± 18.0 and 350.0 ± 27.8, respectively. The mean retrieval number of mediastinal lymph node was 39.0 ± 5.3. There were no severe postoperative complications and there was no postoperative mortality. Mild pleural effusion was occurred in only one patient. Conclusion TMRE with single incision mediastinoscopic approach was technically feasible and oncologically safe procedure for esophageal cancer, especially in patients with old age or with limited cardiopulmonary reserve. Disclosure All authors have declared no conflicts of interest.

VS01.02: MEDIASTINAL LYMPH NODE DISSECTION DURING MINIMAL INVASIVE ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 44-44
Author(s):  
Hirokazu Noshiro ◽  
Yukie Yoda
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Minimally Invasive ◽  
Prone Position ◽  
Lymph Node Dissection ◽  
Conflicts Of Interest ◽  
Mediastinal Lymph Node ◽  
Mediastinal Lymph Node Dissection ◽  
Node Dissection ◽  
Invasive Esophagectomy

Abstract Description As esophageal cancer reveals aggressive characteristics of lymph node metastasis, esophagectomy with extensive lymph node dissection is required as the optimal management in most cases. In spite of improvements in the survival rate, however, the procedure is still associated with significant postoperative morbidity and mortality. As minimally invasive surgery reduces both pain and the systemic inflammatory response, minimally invasive esophagectomy has been developed in an obvious attempt to reduce the incidence of postoperative complications. In addition, the magnified and clear views by thoracoscopy accelerate recognition for the fine and minute surgical anatomy of the mediastinum. Thoracoscopic mobilization of the esophagus and mediastinal lymph node dissection as part of a three-stage procedure was reported in the early 1990s. Recently, thoracoscopic esophageal mobilization and mediastinal dissection in the prone position has been developed. Enhanced visualization and improved ergonomics for surgeons in the prone position provide higher-quality mobilization and lymphadenectomy and contribute to enhancement of the learning curve. Especially, it is favorable during the procedures of upper mediastinal lymph node dissection which are the most complicated ones. During this lymph node dissection, the concept of lymphatic flow is very important. Now, it takes 3 hours and 15 minutes for the thoracic procedure, but the blood loss is less than 100 ml in our recent series. In the presentation, the surgical procedures of thoracoscopic or robotically-assisted esophagectomy in the prone position for esophageal cancer will be demonstrated and our surgical results of over 300 cases will be shown. Disclosure All authors have declared no conflicts of interest.

PS02.131: PATTERN OF LYMPHATIC METASTASIS OF CERVICAL ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 158-158
Author(s):  
Jiancheng Li ◽  
Xiuling Shi
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Conflicts Of Interest ◽  
Mediastinal Lymph Node ◽  
Radical Resection ◽  
Cervical Esophageal Cancer ◽  
Cervical Lymph Nodes ◽  
Node Metastasis

Abstract Background Cervical esophageal cancer were rarely surgeryed Analysis and discussion of lymph node metastasis of cervical esophageal cancer Methods From July 2008 to June 2017, 10 cases of successful esophagectomy of cervical esophageal cance in our hospital underwent radical resection. Surgical dissection range was the neck and the upper mediastinum. A total of 231 lymph nodes were dissected. The lymph nodes were summarized and grouped in different ways, and analyzed the law of lymph node metastasis. Results 7 cases of esophageal cancer, lymph node metastasis occurred, and the rate of lymph node metastasis was 70% (7/10), of which 1 case was T1b stage. 17 lymph node metastases, the degree of lymph node metastasis was 7.36% (17/231), including 4 esophageal lymph nodes, 12 cervical lymph nodes and 1 upper right mediastinal lymph node. Conclusion Cervical esophageal cancer lymph node metastasis can spread occur early metastasis, and the metastasis site were mainly in neck.. Disclosure All authors have declared no conflicts of interest.

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.

RA01.04: A METHOD FOR TOTALLY MEDIASTINOSCOPIC TRANSHIATAL MIDDLE AND LOWER MEDIASTINAL LYMPH NODE DISSECTION FOR ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 18-18
Author(s):  
Akihiro Hoshino ◽  
Yasuaki Nakajima ◽  
Kenro Kawada ◽  
Yutaka Tokairin ◽  
Takuya Okada ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Node Dissection ◽  
Operative Time ◽  
Mediastinal Lymph Node ◽  
Abdominal Cavity ◽  
Mediastinal Lymph Node Dissection ◽  
Node Dissection ◽  
Thoracoscopic Approach ◽  
Transhiatal Approach

Abstract Description Thoracoscopic esophagectomy for esophageal cancer is performed via different approaches at each hospital. In order to reduce the thoracoscopic operative time, we perform mediastinal lymph node dissection via the cervical and transhiatal approach whenever possible before thoracoscopic approach. Recently totally mediastinoscopic transhiatal middle and lower lymph node dissection has been performed, and we will report the method involving constant esophageal traction and esophageal transection in the mediastinum. The mediastinal operational field obtains a clear view by transecting the esophagus on the cranial side. Futhermore, towing the thread sutured the transected esophagus to outside the abdominal cavity makes it possible to achieve good visualization of the mediastinum using the assistant's two retractors. The median total operative time was 507 minutes, and the median thoracoscopic operative time after transhiatal approach was 105 minutes. It is possible to safely perform totally mediastinoscopic middle and lower lymph node dissection with this method. Disclosure All authors have declared no conflicts of interest.

scholarly journals Surgical Benefits of Prone Position Thoracoscopic Esophagectomy Over Open Thoracic and Thoracoscopic Esophagectomy in Left Lateral Decubitus Position: A Literature Review

2020 ◽  
pp. 1-8
Author(s):  
Kazuo Koyanagi ◽  
Kazuo Koyanagi ◽  
Kentaro Yatabe ◽  
Miho Yamamoto ◽  
Soji Ozawa ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Postoperative Complications ◽  
Lymph Nodes ◽  
Mediastinal Lymph Node ◽  
Minimally Invasive Esophagectomy ◽  
Node Dissection ◽  
Invasive Esophagectomy ◽  
Left Lateral Decubitus Position ◽  
Lateral Decubitus

Objective: We reviewed the surgical outcomes of minimally invasive esophagectomy (MIE), especially the number of lymph nodes retrieved, for the patients with esophageal cancer to clarify the surgical benefits of MIE in patients with esophageal cancer. Material and Methods: A systematic literature search was performed, and articles that fully described the surgical results of MIE were selected. Parameters such as operative time, blood loss, the number of lymph nodes retrieved, and postoperative complications were compared among patients undergoing minimally invasive esophagectomy (MIE) in the left lateral decubitus position (MIE-LP), MIE in the prone position (MIE-PP), and open thoracic esophagectomy (OE). Results: The conversion rate from MIE to OE was very low. MIE-PP was associated with lower blood loss than OE and MIE-LP. Results of a multicenter randomized controlled trial demonstrated that pneumonia and recurrent laryngeal nerve paralysis in MIE-PP significantly reduced compared with OE. Although postoperative complications were not different between MIE-PP and MIE-LP, the number of lymph nodes retrieved in MIE-PP was higher than that in MIE-LP. Conclusion: MIE-PP has potential benefits in terms of less surgical invasiveness and improvement of mediastinal lymph node dissection. A prospective randomized control trial using a large number of cases and long-term follow-up is recommended for analyses of appropriate mediastinal lymph node dissection and its impact on oncological benefit.

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

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.

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