Yo Kurashima, MD, PhD. Hokkaido University
Introduction: The number of Gastroesophageal junction cancer has been increasing in recent years, however the consensus has not yet been reached on the range of optimal lymph node dissection. In addition, the approach to lower mediastinal lymph node dissection and reconstruction has some options as laparoscopic and thoracoscopic surgery for gastroesophageal junction cancer. In this presentation, we focus on the procedure of lower mediastinal lymph node dissection and reconstruction by laparoscopy and left side thoracoscopy combination, which we perform against advanced Siewert type II of gastroesophageal junction cancer.
Surgical procedure: We perform proximal gastrectomy with intraperitoneal lymph node dissection, lower esophageal resection with lower mediastinal lymph node dissection, and double tract reconstruction for advanced Siewert type II of gastroesophageal junction cancer. The setting is the lithotomy and the right side half decubitus position. In the first half of the operation, intraperitoneal surgery is performed by co-axial setting. In the left thoracoscopic operation, the trocars were placed in the left 8th, 9th, 11th intercostal spaces. The thoracoscopic lower mediastinal lymph node dissection, lower esophageal dissection and reconstruction were performed finally in the lower mediastinum. With a good view through thoracoscopy, it is possible to secure lymph node dissection and safe reconstruction.
Short Term Results: We performed the procedure for 5 cases of gastroesophageal junction cancer from 2013 to 2016. The median operative time was 436 minutes, the median hemorrhage volume was 15g. There was no postoperative complication including anastomosis leakage. The median length of postoperative hospital stay was 15 days.
Conclusion: The combined approach of laparoscopy and left thoracoscopy to advanced Siewert type II of gastroesophageal junction cancer is useful for reliable lymphadenectomy, securing sufficient margin and safe anastomosis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86462
Program Number: V060
Presentation Session: Thursday Exhibit Hall Theater (Non CME)
Presentation Type: EHVideo
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