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A novel technique of single-port thoracic-assisted totally laparoscopic esophagogastrectomy for Siewert type 2 adenocarcinoma of esophagogastric junction

Wei Wang, Wenjun Xiong, Jin Wan, Xiaofeng Zhu. Guangdong Provincial Hospital of Chinese Medicine

Background: The incidence of Siewert type ? adenocarcinoma of esophagogastric junction (AEG) is increasing, especially in Asia, but laparoscopic surgery for type 2 AEG is not widely accepted due to the technical challenges and unknown prognosis. To address this problem, we developed a novel technique of single-port thoracic-assisted laparoscopic esophagogastrectomy.

Methods: From January 2017 to August 2018, 13 consecutive patients with advanced Siewert type 2 AEG underwent single-port thoracic-assisted laparoscopic radical esophagogastrectomy. After completly abdominal lymphadenectomy and mobilization of the stomach laparoscopically, the left diaphragm was incised 5 to 7 cm, followed by a transthoracic assisted port was inserted into the thoracic cavity through the left axillary frontline at the sixth to eighth intercostal spaces. Then lower mediastinal lymphadenectomy and transection of the lower esophagus were completed with the transthoracic supplementary port. An intrathoracic Roux-en-Y esophagojejunostomy was performed by using the transthoracic assisted port, which was finally used for thoracic drainage.

Results: All procedures were completed successfully without surgical morbidity and mortality. The median operative time was 380.5 (255.0-480.0) min. The time for reconstruction was 40 (29 to 52) min including 28 (20 to 35) min for intrathoracic esophagojejunostomy and 12 (10 to 17) min for extraperitoneal jejunojejunostomy. The median blood loss was 200 (60.0-500.0) ml. The median tumor diameter was 4.2 (2.5 to 6.7) cm with a median esophagus invasion of 2.2 (0.6 to 3.5) cm. The median number of lymph nodes harvest was 45 (37 to 60). The median numbers of lower mediastinal lymph nodes and metastatic mediastinal lymph nodes were 4(0-10)and 1(0-3, respectively. The rate of metastatic mediastinal lymph nodes was 24.4%. Metastatic mediastinal lymph nodes were harvested from 6 patients (6/12, 50.0%). The median time of first flatus was 4 (2 to 7) days. The median hospital stay was 12 (10 to 17) days. One patient developed a thoracic infection and was cured with thoracic drainage and antibiotic treatment.

Conclusions: Our initial result suggested that this novel technique was safe and feasible for Siewert type 2 AEG, associated with the advantages of complete lower mediastinal lymphadenectomy and easy intrathoracic Roux-en-Y esophagojejunostomy by using the transthoracic assisted port.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 93426

Program Number: P468

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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