Transabdominal Approach for Chylorrhea after Esophagectomy by Using Fluorescence Navigation with Indocyanine Green

A 70-year-old man who underwent two sessions of thoracoscopy-assisted ligation of the thoracic duct to treat refractory chylorrhea after radical esophagectomy for advanced esophageal cancer received conservative therapy. However, there was no improvement in chylorrhea. Then, transabdominal ligation of the lymphatic/thoracic duct at the level of the right crus of the diaphragm was performed using fluorescence navigation with indocyanine green (ICG). The procedure successfully reduced chylorrhea. This procedure provides a valid option for persistent chylothorax/chylous ascites accompanied by chylorrhea with no response to conservative treatment, transthoracic ligation, or both.

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Laparoscopic Transhiatal Thoracic Duct Ligation for Chylothorax after Esophagectomy

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0038-1677507 ◽

2019 ◽

Vol 67 (07) ◽

pp. 606-609 ◽

Cited By ~ 1

Author(s):

Yukinori Yamagata ◽

Kazuyuki Saito ◽

Kosuke Hirano ◽

Masatoshi Oya

Keyword(s):

Esophageal Cancer ◽

Conservative Treatment ◽

Thoracic Duct ◽

Thoracic Cavity ◽

Transthoracic Approach ◽

Thoracic Esophageal Cancer ◽

Transhiatal Approach ◽

Thoracic Duct Ligation ◽

Duct Ligation ◽

Laparoscopic Transhiatal Approach

AbstractIn esophagectomy for thoracic esophageal cancer, chylothorax may develop at a certain frequency. For chylothorax, conservative treatment is selected first, but if it is not improved, thoracic duct (TD) ligation is considered. In general, transthoracic approach is chosen to reach the TD. However, it is sometimes difficult to identify the TD due to adhesion in the thoracic cavity. Hence, we selected a laparoscopic transhiatal approach to the TD. We introduce the procedure of our laparoscopic transhiatal TD ligation technique.

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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

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.235 ◽

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.

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A Case Report of Esophageal Perforation into the Right Thorax with Advanced Esophageal Cancer Caused by Vomiting.

The Japanese Journal of Gastroenterological Surgery ◽

10.5833/jjgs.29.2279 ◽

1996 ◽

Vol 29 (12) ◽

pp. 2279-2283 ◽

Cited By ~ 2

Author(s):

Osamu Chino ◽

Hiroyasu Makuuchi ◽

Kyouichi Mizutani ◽

Takao Machimura ◽

Hideo Shimada ◽

...

Keyword(s):

Esophageal Cancer ◽

Case Report ◽

Esophageal Perforation ◽

Advanced Esophageal Cancer ◽

The Right

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Advanced Esophageal Neoplasm with Subcutaneous Metastasis

Case Reports in Oncological Medicine ◽

10.1155/2019/9103137 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Rivadávio A. M. de Oliveira ◽

Tassiara da Silva ◽

Mariana Miyasaki Piovesana ◽

Carlos Eduardo Stecca ◽

George A. Lopes ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Esophageal Cancer ◽

Case Report ◽

Lymph Node ◽

Pulmonary Metastases ◽

Stage Iv ◽

Esophageal Neoplasm ◽

Advanced Esophageal Cancer ◽

Rare Presentation ◽

The Right

Objective. This report is aimed at describing a rare clinical condition of advanced esophageal cancer with subcutaneous metastasis. Case Report. The present case refers to a patient diagnosed with stage IV esophageal squamous cell carcinoma which started with dysphonia and cervical nodules. Soon after that, the patient developed dysphagia and subcutaneous lesions on the right flank. Later in time, we documented a disease progression, with worsening of subcutaneous implants, lymph node, bone, and pulmonary metastases in addition to malignant hypercalcemia. Conclusion. This illustrates a rare presentation of an advanced esophageal neoplasm. Subcutaneous metastasis from internal malignancies is unusual, corresponding to less than 10% of cases. Its occurrence in patients with esophageal cancer is even less common with very few cases reported in literature.

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Presentation and progression of a disc cyst in a pediatric patient

Journal of Neurosurgery Pediatrics ◽

10.3171/2010.11.peds10227 ◽

2011 ◽

Vol 7 (2) ◽

pp. 209-212 ◽

Cited By ~ 5

Author(s):

Ning Lin ◽

Clemens M. Schirmer ◽

Mark R. Proctor

Keyword(s):

Conservative Treatment ◽

Intervertebral Disc ◽

Medical Records ◽

Conservative Therapy ◽

Pediatric Population ◽

Lumbar Disc ◽

Adult Population ◽

Cyst Excision ◽

The Right ◽

Intraspinal Cyst

Disc cysts are rare intraspinal extradural lesions that communicate with the intervertebral disc and can mimic the symptoms of acute lumbar disc herniation. Initially reported in the Japanese-language literature as a new entity (discal cyst), there are few documented cases in North America, and only 1 prior case in the pediatric population. The authors present the case of a 16-year-old girl with an intervertebral disc cyst causing lumbar radiculopathy that progressed despite conservative treatment. All medical records, imaging studies, intraoperative findings, and pertinent literature were reviewed. Serial preoperative MR imaging revealed enlargement of the intraspinal cyst at the L4–5 level, resulting in compression of the right L-5 nerve root. Enlargement of the cyst occurred over a 4-month period despite conservative treatment with physical therapy and corticosteroid injections. Microsurgical discectomy and excision of the cyst resulted in complete resolution of the preoperative radiculopathy. An intervertebral disc cyst is a rare entity in the adult population and exceedingly rare in the pediatric population but should remain in the differential diagnosis of any intraspinal extradural mass. The authors hypothesize that there exists a spectrum of this entity that may not be responsive to conservative therapy. Cyst excision alone or in conjunction with microsurgical discectomy is safe and effective in treating radiculopathy caused by disc cysts.

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Helical tomotherapy for advanced esophageal cancer improves target conformity and homogeneity: A comparison with fixed-field intensity-modulated radiotherapy

JOURNAL OF ADVANCES IN PHYSICS ◽

10.24297/jap.v11i3.471 ◽

2015 ◽

Vol 11 (3) ◽

pp. 3146-3155

Author(s):

Luhua Wang

Keyword(s):

Esophageal Cancer ◽

Field Intensity ◽

Helical Tomotherapy ◽

Intensity Modulated Radiotherapy ◽

Matched Pair ◽

Conformity Index ◽

Target Coverage ◽

Advanced Esophageal Cancer ◽

Fixed Field ◽

Intensity Modulated

Purpose: To evaluate the usefulness of helical tomotherapy (HT) in the treatment of advanced esophageal cancer (EC) and compare target homogeneity, conformity and normal tissue doses between HT and fixed-field intensity-modulated radiotherapy (ff-IMRT).Methods: In all, 23 patients with cT3-4N0-1M0-1a thoracic EC (upper esophagus, 9 patients; middle esophagus, 6; distal esophagus, 6 and esophagogastric junction, 2) who were treated with ff-IMRT (60 Gy in 30 fractions) were re-planned for HT and ff-IMRT with the same clinical requireÂments. Comparisons were performed using the Wilcoxon matched-pair signed-rank test.Results: Compared with ff-IMRT, HT significantly reduced the homogeneity index for thoracic, upper, middle and distal ECs by 38%, 31%, 36% and 33%, respectively (P < 0.05). The conformity index was increased by HT for thoracic, upper and middle ECs by 9%, 9% and 18%, respectively (P < 0.05). Target coverage was improved by 1% with HT (P < 0.05). The mean lung dose was significantly reduced by HT for thoracic and upper ECs (P < 0.05). The V20 (volume receiving at least 20 Gy) and higher dose volumes of the lungs were decreased by HT in all cases, but the differences were significant for thoracic, upper and distal ECs (P < 0.05), with reductions of 2.1%, 3.1% and 2.2%, respectively. HT resulted in a larger lung V5 for thoracic, upper, middle and distal ECs, with increases of 3.5%, 1.5%, 7.2% and 3.2%, respectively. Heart sparing was significantly better with HT than with ff-IMRT in terms of the V30 and V40 for thoracic, upper, middle and distal ECs (P < 0.05).Conclusions: Compared to ff-IMRT, HT provides superior target coverage, conformity and homogeneity, with reduced the volume of high doses to the lungs and heart for advanced EC. HT may be a treatment option for advanced EC, especially upper EC.

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