Esofagotomia cervical para retirada de anzol de pesca em um espécime de Cágado do Nordeste (Mesoclemmys tuberculata) no Parque Zoobotânico Arruda Câmara – Relato de Caso / Cervical esophagectomy for removal of fishing hook in a specimen of northeast tortoise (Mesoclemmys tuberculata) in the Zoobotanic Park Arruda Câmara - Case Report

O Mesoclemmys tuberculata, comumente conhecido como cágado do nordeste, é uma espécie endêmica do nordeste brasileiro e, podem ser encontrados nas caatingas e agreste, além do rio São Francisco e bacias adjacentes. Dentre as afecções que acometem esses animais, a ingestão de anzóis e linhas de pesca se apresentam normalmente como um achado acidental em radiografias, podendo causar lesões graves no trato gastrointestinal. As indicações para cirurgia esofágica incluem corpos estranhos, tumores, perfurações, estenoses, entre outros. Em comparação com as cirurgias realizadas em outras regiões do trato digestivo, estas requerem mais cuidados no pós operatório, e o manejo alimentar é um dos fatores que determinam o sucesso do procedimento cirúrgico. O presente trabalho tem como objetivo relatar o caso de um espécime de cágado do nordeste encaminhado pela Polícia Ambiental para o setor ambulatorial do Parque Zoobotânico Arruda Câmara. Posteriormente ao exame clínico, observou a presença de um anzol de pesca em região de terço proximal do esôfago. O animal encontrava-se estável e foi encaminhado para o centro cirúrgico para retirada do corpo estranho. Após 15 dias sem nenhuma complicação pós-cirúrgica, o animal recebeu alta e foi encaminhado para soltura no próprio Parque.

Free partial patch and partial tube jejunal graft transfers were used to reconstruct pharyngoesophageal defect: Our experience with three cases

Those patients with hypopharyngoesophageal cancer often sacrificed larynx before reconstruction using jejunum to restore the continuity of the digestive tract and allow oral alimentation. We retrospectively collected and analyzed three patients who underwent hypopharyngoesophageal reconstruction by free partial patch and partial tube jejunal graft transfer with reservation of laryngeal function caused by hypopharyngeal cancer invading the cervical esophagus. The partial patch and partial tube jejunal graft transfer survival rate was 100%(3/3). The larynx was reserved in the three patients. The partial patch and partial tube jejunal graft transfer is a safe and reliable choice for reconstruction of large and complex defects after pharyngectomy and cervical esophagectomy with larynx preserved.

Surgical anatomy of the upper esophagus related to robot-assisted cervical esophagectomy

Robot-assisted cervical esophagectomy (RACE) enables radical surgery for tumors of the middle and upper esophagus, avoiding a transthoracic approach. However, the cervical access, narrow working space, and complex topographic anatomy make this procedure particularly demanding. Our study offers a stepwise description of appropriate dissection planes and anatomical landmarks to facilitate RACE. Macroscopic dissections were performed on formaldehyde-fixed body donors (three females, three males), according to the surgical steps during RACE. The topographic anatomy and surgically relevant structures related to the cervical access route to the esophagus were described and illustrated, along with the complete mobilization of the cervical and upper thoracic segment. The carotid sheath, intercarotid fascia, and visceral fascia were identified as helpful landmarks, used as optimal dissection planes to approach the cervical esophagus and preserve the structures at risk (trachea, recurrent laryngeal nerves, thoracic duct, sympathetic trunk). While ventral dissection involved detachment of the esophagus from the tracheal cartilage and membranous part, the dorsal dissection plane comprised the prevertebral compartment harboring the thoracic duct and right intercosto-bronchial artery. On the left side, the esophagus was attached to the aortic arch by the aorto-esophageal ligament; on the right side, the esophagus was bordered by the azygos vein, right vagus nerve, and cardiac nerves. The stepwise, illustrated topographic anatomy addressed specific surgical demands and perspectives related to the left cervical approach and dissection of the esophagus, providing an anatomical basis to facilitate and safely implement the RACE procedure.

Robot-assisted cervical esophagectomy: first clinical experiences and review of the literature

Summary Pulmonary complications, and especially pneumonia, remain one of the most common complications after esophagectomy for esophageal cancer. These complications are reduced by minimally invasive techniques or by avoiding thoracic access through a transhiatal approach. However, a transhiatal approach does not allow for a full mediastinal lymphadenectomy. A transcervical mediastinal esophagectomy avoids thoracic access, which may contribute to a decrease in pulmonary complications after esophagectomy. In addition, this technique allows for a full mediastinal lymphadenectomy. A number of pioneering studies have been published on this topic. Here, the initial experience is presented as well as a review of the current literature concerning transcervical esophagectomy, with a focus on the robot-assisted cervical esophagectomy procedure.

282 CERVICAL ESOPHAGECTOMY USING “LARYNX ROTATION METHOD” CAN OBTAIN GOOD CLINICAL OUTCOMES.

In the treatment of cervical esophageal carcinoma (CEC), preservation of laryngeal function is required as well as curability. Therefore, chemoradiotherapy (CRT) is often selected for larynx-preservation. In our department, larynx-preserving surgery using “larynx-rotation method” is aggressively carried out even when the oral side of the tumor margin extends beyond the esophageal orifice. In this study, we analyzed the clinical outcomes of the resectable CEC and examined ``Which therapeutic modality should be selected, surgery or CRT?'' Methods In the present study, 40 patients whose primary tumor was resectable Stage II/III CEC treated in our department since 2008, whose advanced primary tumor lesion was limited within cervical esophagus, and who undergo surgery or curative CRT were enrolled. The clinical outcomes were retrospectively analyzed. Results The Op group included 25 patients. All of the Op group patients could preserve the larynx. In the CRT group, 2 patients were performed pharyngo-laryngo-cervical esophagectomy as the salvage surgery. 1- and 3-year progression-free survival rate was 80.1 and 69.3% in the Op group, and 63.0 and 31.5% in the CRT group. 1-, 3- and 5-year overall survival rate was 95.8, 80.9 and 67.4% in the Op group and 78.6, 64.3 and 46.9% in the CRT group, respectively. Although there was no significant difference, the Op group showed relatively better clinical outcomes. Conclusion Cervical esophagectomy using “larynx-rotation method” could obtain good therapeutic outcomes while preserving the larynx. Especially in case cervical esophagectomy is sufficient as the curative resection, because the surgical invasion is little and the postoperative quality of life is good while preserving the larynx and the whole stomach, surgery is considered useful treatment modality.

PS01.126: LYMPH NODE METASTASES AND NECK DISSECTION FOR THE PATIENTS WITH CERVICAL ESOPHAGEAL CANCER

Background Cervical esophageal cancer (CEC) is a relatively rare disease but the outcomes of the patients with CEC are often poor. Lymph node metastases in the neck sometimes play a crucial role to treat the patients. The aim of this study is to evaluate the lymph node metastases and neck dissection for the patients with CEC. Methods Retrospective review of the records of the patients. Five patients with CEC who underwent total pahryngo-laryngectomy plus cervical esophagectomy were enrolled in this study. We analyzed the places of lymph node metastases of the patients and the relationship of the patients’ outcome. Results Four of the patients underwent free jejunum flap reconstruction after total pahryngo-laryngectomy plus cervical esophagectomy and the other one underwent gastric tube plus free jejunum flap reconstruction after the pahryngo-laryngectomy plus total esophagectomy. All patients underwent bilateral neck dissection. One patient underwent chemoradiotherapy as an initial treatment and he had no lymph node metastasis by pathological examination. The other four patients had neck metastases to some extent. Three of them had bilateral lymph node metastases and the other had one metastatic lymph node. Especially one patient had left upper lateral neck metastasis and right Rouvier lymph node metastasis. Conclusion These results indicated that patients with CEC should undergo bilateral neck dissection and if possible, Rouvier lymph node should also be resected during radical surgery. Disclosure All authors have declared no conflicts of interest.