Lower thoracic esophagectomy, lymphadenectomy of lower mediastinum and anastomosis in VATS-E for esophago-gastric junction cancer

Toshiyuki Irie, MD¹, Hiroshi Makino, MD¹, Hiroshi Yoshida, MD¹, Hiroshi Maruyama, MD¹, Yuta Kikuchi, MD¹, Koji Ueda, MD¹, Masafumi Yoshioka, MD¹, Hideyuki Takata, MD¹, Daisuke Kakinuma, MD², Yoshikazu Kanazawa, MD², Itsuro Fujita, MD², Nobuyuki Sakurazawa, MD³, Masao Miyashita, MD³, Eiji Uchida, MD². ¹Department of Surgery, Nippon Medical School, Tama-Nagayama Hospital, ²Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, ³Department of Surgery, Nippon Medical School, Chiba-Hokusoh Hospital

Introduction: The number of of esophago-gastric junction (EGJ) cancer case is increasing in Japan year by year. The aim of this study is to clarify the safe and adequate VATS-E procedure for lymph nodes (LNs) dissection and anastomosis for EGJ cancer.

Background: The 14% of lower mediastinal LNs metastasis or recurrence was found in totally 29 consecutive patients with EGJ cancer from 1999 to 2005 in our Hospital. Widespread LN metastasis from squamous cell carcinoma (SCC) was found in neck, mediastinum and abdomen, and abdomen from Adenocarcinoma (ADC). Frequent LN metastasis from Adenocarcinoma (ADC) was found in abdomen.

Methods: For Siewert type I, EGJ cancer, we performed the same VATS-E operation for the esophageal cancer.

Patients

For Siewert type II, EGJ cancer right thoraco-laparo consecutive incision and trans-thoracic esophagectomy was performed from 2007 to 2012 (n=3). For minimally invasive surgery, VATS-E and laparoscopic or open proximal gastrectomy for EGJ cancer are performed from 2014 (n=11). Three ports are used at the 7th, 9th and 5th intercostal space (ICS) for VATS-E and lower thoracic esophagectomy and lower mediastinal LN dissection were performed with pneumothorax by maintaining CO2 insufflation. Esophago-gastric anastomosis are created by functional end to end anastomosis or orvil system in the chest.

Results:

1. There are no complication except for a case with minor anastomotic leakage in VATS-E.

2. Wide operative field is available in the chest for lymph-node dissection of lower mediastinum and anastomosis for EGJ cancer in VATS-E.

Conclusion: VATS-E allows us to perform the feasible and safe reconstruction as well as mediastinal LNs dissection.

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

Abstract ID: 86949

Program Number: P455

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster