S Tadano, MD, Y Izumi, MD PhD, T Ryotokuji, MD, A Miura, MD PhD, T Kato, MD, M Yoshida, MD PhD. Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital
BACKGOUND: Esophageal squamous cell cancer located in the lower third of the esophagus often indicates surgery with left transthoracic approach. Surgery with left thoracotomy is less invasive than right thoracotomy, but thoracotomy itself is associated with morbidity and delayed recovery in cancer patients who are typically older and malnourished and often have pulmonary or cardiovascular complications.
CASE: A 65-year-old man diagnosed as esophageal carcinoma introduced our hospital. After further examinations, he was diagnosed as early Barrett adenocarcinoma and operation was performed. We conducted lower third esophagectomy with laparoscopic transhiatal approach and esophago-jejunostomy using a circular stapler. Following these procedures, we used left thracoscopy for the observation in the intrathracic anastomosis. The thoracoscopic examination revealed the completion of the anastomosis and the insufficiency of blood supply at the stump of jejunum. We performed the resection of the stump and finished operation. He was discharged without any complications on postoperative day 25 and remains alive 9 years.
DISCUSSION: The laparoscopic transhiatal approach was efficient in patients with distal esophageal cancer. However, we often faced difficulty in the intrathracic anastomosis. The observation of the intrathracic anastomosis using left thoracosopy is useful to decrease the complication of the leakage. We could observe ischemia of the stump of jejunum and cut the stump using left thoracosopy in this case.
CONCLUSION: The laparoscopic transhiatal approach combined with left thoracoscopy technique becomes more reliable method for the esophageal cancer in the lower third and gastro-esophageal junction.
Program Number: P302