PS02.006: OPERATIVE INDICATION AND PROCEDURES OF THORACOSCOPIC ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 121-121
Author(s):  
Takashi Kamei
Keyword(s):  
Esophageal Cancer ◽  
Survival Rate ◽  
Prone Position ◽  
Neoadjuvant Treatment ◽  
Thoracoscopic Esophagectomy ◽  
Operative Indication ◽  
Definitive Chemoradiotherapy ◽  
Long Term Outcome ◽  
Thoracoscopic Approach ◽  
Left Lateral Decubitus Position

Abstract Background Thoracoscopic esophagectomy has been performed for two decades and becomes widely spread. We evaluate our cases who undergone the thoracoscopic esophagectomy and consider the future prospective of this operation. Methods 702 patients who received thoracoscopic esophagectomy in our institute from March 1995 to October 2017 were enrolled and studied retrospectively. Operative indication is an all of the clinically resectable cases including with a neoadjuvant treatment or definitive chemoradiotherapy before surgery. Overall survival rate of the patients with thoracoscopic approach and with thoracotomy until 2001 was analyzed. Long term outcome of the patients with thoracoscopic esophagectomy was compared to the result from comprehensive registry of esophageal cancer in Japan. Short term results of the perioperative parameters were analyzed between left lateral decubitus position and prone position. Results There was no significant differences of the survival rate between thoracoscopic group and thoracotomy group based on pathological stage. 5 year survival without neoadjuvant treatment was 88.9% (pStageI), 71.5%(pStageIIA), 68.1%(pStageIIB), 40.9%(pStageIII), respectively.5 year survival rate of cStageII and III with neoadjuvant chemotherapy was 65.7% and 5 year survival rate of the salvage esophagectomy after failure of definitive chemoradiotherapy was 31.4%. Every outcomes are as good as any reported results in esophagectomy. In the comparison of the lateral position with the prone position, total blood loss was significantly lower in prone position. Inflammatory response after surgery was improved more rapidly in prone group, therefore, prone position is recommended as a minimally invasive procedure for thoracoscopic esophagectomy. Conclusion Thoracoscopic esophagectomy will develop further as a standard operation for esophageal cancer. However, from the point of view of the safety, an appropriate educational systems of this advanced procedure should build. Disclosure All authors have declared no conflicts of interest.

535 EVALUATION OF THORACOSCOPIC ESOPHAGECTOMY FOR ESOPHAGEAL CANCER FROM 650 CASES IN A SINGLE INSTITUTE

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Takashi Kamei ◽  
Yusuke Taniyama ◽  
Hiroshi Okamto
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Treatment ◽  
Thoracoscopic Esophagectomy ◽  
Long Term Results ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Left Lateral Decubitus Position ◽  
Lateral Decubitus ◽  
Almost All

Abstract   Minimally invasive surgery (MIS) for esophageal cancer has been wide-spreading in worldwide since the first report in 1992. In Japan, we firstly introduced thoracoscopic esophagectomy as a MIS for esophageal cancer in 1994 and performed more than 650 cases over the last two decades. The aim of the present study is to evaluate an oncological feasibility and less invasiveness of this operation from short and long term results. Methods Thoracoscopic esophagectomy was performed in almost all resectable thoracic esophageal cancer patient, briefly indication for this operation is cT1-T3 tumors and lymph node involvement within the regional lesion. We performed thoracoscopic esophagectomy with one lung ventilation in left lateral decubitus position (Group L) up to 2011. From 2012, prone thoracoscopic esophagectomy with bilateral ventilation and artificial pneumothorax (Group P) has been undergone. We analyzed the long-term outcome in all patients who received thoracoscopic esophagectomy with or without neoadjuvant treatment. Furthermore, we evaluated the less invasiveness from the results of short-term outcome and operation-related morbidity between Group L and Group P. Results The 5-year survival rates in no treatment before surgery cases were 61.9% overall, and 86.9%, 71.5%, 68.1%, 40.9%, 37.4% for pathological stages I, IIA, IIB, III and IVa, respectively (TNM classification 6th edition). 30 days mortality in this series was 0.6%. 5-year survival in cStage II and III with neoadjuvant chemotherapy was 65.7%. 3-year survival in salvage esophagectomy after failure of definitive chemoradiotherapy with R0 resection was 43.0%. Total amount of blood loss, rate of postoperative pulmonary complications and the postoperative inflammatory response were significantly lower in Group P than in Group L. Conclusion Thoracoscopic esophagectomy is safety and oncologically feasible. From the view point of less invasiveness benefits, prone esophagectomy has advantages than lateral decubitus procedure and this operation is recommended in almost all patients with a resectable esophageal cancer.

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.

RA04.01: PRONE POSITION IN THORACOSCOPIC ESOPHAGECTOMY IMPROVES POSTOPERATIVE OXYGENATION AND REDUCES PULMONARY COMPLICATIONS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 24-25
Author(s):  
Yoshihiro Kakeji ◽  
Dai Otsubo ◽  
Gosuke Takiguchi ◽  
Taro Oshikiri ◽  
Tetsu Nakamura
Keyword(s):  
Pulmonary Function ◽  
Prone Position ◽  
Surgical Procedure ◽  
Body Position ◽  
Lateral Decubitus Position ◽  
Thoracoscopic Esophagectomy ◽  
Respiratory Complications ◽  
Left Lateral Decubitus Position ◽  
Lateral Decubitus ◽  
Position Group

Abstract Background While thoracoscopic esophagectomy is a widely performed surgical procedure, only few studies regarding the influence of body position on changes in circulation and breathing, after the surgery, have been reported. This study aimed at evaluating the effect of body position, during surgery, on the postoperative breathing functions of the chest. Methods A total of 266 patients who underwent right-sided transthoracic esophagectomy for esophageal cancer from 2004 to 2012 were included in this study. Fifty-four of them underwent open thoracotomies in the left lateral decubitus position (Group O), 108 underwent thoracoscopic esophagectomy in the left lateral decubitus position (Group L) and 104 patients were treated by thoracoscopic esophagectomy in the prone position (Group P). Two patients in Group P, who presented with intra-operative bleeding and underwent thoracotomy, were subsequently excluded from the pulmonary function analysis. Results Two patients in Group P had to be changed from the prone position to the lateral decubitus position and underwent thoracotomy in order to control intra-operative bleeding. Despite the significantly longer chest operation period in Group P, total blood loss was significantly lower in this group when compared to Groups O and L. Furthermore, patients in Group P presented with significantly lower water balance during the perioperative period and markedly higher SpO2/FiO2 ratio after the surgery. The incidence of respiratory complications was significantly higher in Group O when compared to the other two groups; however, no significant differences were observed between the Groups L and P. Conclusion From a surgical point of view, artificial pneumothorax and gravity improves the operative field view in the prone position without any compression of the right lung, thereby resulting in no mechanical damage to the lungs. Prone position esophagectomy is a useful surgical technique, which appears to preserve the postoperative pulmonary function. The patients are able to endure the surgical procedure and present with less respiratory complications. Disclosure All authors have declared no conflicts of interest.

PS02.031: DEFINITIVE CHEMORADIOTHERAPY WITH DOCETAXEL, CISPLATIN, AND 5-FLUOROURACIL (DCF-R) FOR ADVANCED CERVICAL ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 128-129
Author(s):  
Hiroshi Okamoto ◽  
Yusuke Taniyama ◽  
Tadashi Sakurai ◽  
Takahiro Heishi ◽  
Chiaki Sato ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Survival Rate ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Conflicts Of Interest ◽  
Clinical Stage ◽  
Stage Ii ◽  
Definitive Chemoradiotherapy

Abstract Background Recently, definitive chemoradiotherapy (dCRT) has become one of the essential treatment strategies for esophageal squamous cell carcinoma (ESCC) and has been especially gaining prevalence for cervical ESCC to preserve the larynx. There have been recent reports on favorable outcomes of docetaxel/CDDP/5-FU (DCF-R) for advanced esophageal cancer. Our department recently introduced DCF-R for treating advanced cervical ESCC. We analyzed the safety and outcomes of DCF-R in patients with advanced cervical ESCC. Methods We retrospectively evaluated 12 advanced cervical ESCC patients (clinical stage II–IV, including T4b and/or M1 lymph node) in our department who received DCF-R as the first-line treatment between December 2010 and February 2015. Results Our patient cohort comprised 9 males and 3 females (median age, 67.5 years; range: 54–76 years). All patients were squamous cell carcinoma. The median observation period was 34.5 (8–80) months with total irradiation dose of 64.0 (60–70) Gy. The pretreatment clinical stage (according to Union for International Cancer Center) included one stage II, seven stage III, and four stage IV cases (including 3 patients with T4b [2 trachea and 1 thyroid] and 4 patients with M1 lymph node. We attained complete response (CR) in 10 patients and stable disease in 2 patients. Of 10 patients with CR, 5 experienced recurrence and 5 continued exhibiting CR. Two persistent patients included one patient who died of cancer and one patient who underwent salvage surgery. Furthermore, grade 3 or more adverse events as defined in Common Terminology Criteria for Adverse Event version 4 included leucopenia (91.7%), neutropenia (91.7%), febrile neutropenia (50%), and pharyngeal pain (50%). There was no treatment-related mortality and treatment schedules were completed in all patients, although dose reduction of the second cycle of chemotherapy was required in four patients (33%) and change in the radiation schedule was required in one patient (8.3%). While the 2-/3-/5-year overall survival rate was 66.7%/48.6%/48.6%, the 2-/3-/5-year recurrent-free survival rate was 58.3%/50.0%/37.5%, respectively. Conclusion DCF-R treatment for advanced cervical ESCC could be completed by the careful administration, and although a strong blood toxicity might occur, a favorable prognosis can be obtained with larynx preservation. Disclosure All authors have declared no conflicts of interest.

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