175. OPTIMIZING MEDIASTINAL ACCESS FOR RADICAL ESOPHAGECTOMY: A BILATERAL CERVICAL AND TRANSHIATAL APPROACH TO RESECT ESOPHAGEAL CANCER

Abstract

Abstract Background Major medical centers have gradually attempted and promoted esophagectomy via mediastinal approach. However, this operation is challenging and requires a high level of technical proficiency from surgeons because of the limited space and restricted visibility of the mediastinum. The current surgical method limits its application in patients with locally advanced esophageal cancer, which underscores an urgent need for optimization to facilitate its refinement and dissemination. Methods We have implemented the following enhancements to the surgical procedure: 1. The cervical level was chosen for transecting the esophagus, and then the proximal esophageal stump was pulled down and invaginated. 2. Bilateral cervical incisions were made, with a small 0.5 cm incision at the anterior edge of the right sternocleidomastoid muscle. 3. The position of abdominal surgical incisions was adjusted so that all incisions were located on the left side of the abdominal midline. 4. A portion of the left diaphragm was dissected. 5. During the superior mediastinum procedure, gauze was positioned within the expanded superior mediastinum. Results 1. The surgical field was fully exposed, expanding the operative space for upper mediastinal surgery. 2. The difficulty of this surgery was reduced, and it was easier to expose both RLNs and completely remove the mediastinal lymph nodes. 3. The 106recR could be completely removed under endoscopy. 4. The thoracic duct could be fully exposed and freed. 5. During surgery, gauze is placed in the upper mediastinum to aid in hemostasis and improve visibility. 6. Even if the tumor was slightly larger or locally invaded surrounding tissues, it could be completely resected. 7.Complete resection of the esophageal mesorectum was successfully achieved. Conclusion Esophagectomy for esophageal cancer via bilateral cervical and transhiatal approach can achieve radical resection and can be applied to patients with locally advanced esophageal cancer. This surgical method expands the surgical indications, reduces the surgical difficulty for surgeons, and facilitates the promotion and popularization of the mediastinal approach surgery. Video address: https://www.icloud.com.cn/iclouddrive/085wyZDN6Qqm6Ou06fhOsi-Rw#2023_ISDE_abstract_video