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.
Evaluation of cervical and extended upper mediastinal lymph node dissection for thoracic esophageal cancer in relation to quality of life.
