Abstract
Abstract We reported the esophagus, trachea, recurrent laryngeal nerves (RLNs), and regional lymph nodes are contained in a common compartment, which we named mesotracheoesophagus. We believe complete resection of the mesotracheoesophagus is ‘mesenteric excision’ for esophageal cancer, which is the fundamental principle of intestinal cancer surgery. Since June 2011, we have performed minimal invasive esophagectomy (MIE) based on this concept. This study was aimed to evaluate outcomes of our MIE. Methods We performed a retrospective study of patients with esophageal cancer who underwent MIE at our hospital between June 2011 and March 2019. Procedure First, the dorsal side of the esophagus was dissected along a dissectable layer recognized outside the mesotracheoesophagus. After complete mobilization of the dorsal side of the esophagus, the trachea and RLNs were released from the mesotracheoesophagus and the rest of the fat tissue was dissected for radical LN dissection in the upper mediastinum. Results We identified consecutive 151 eligible patients. The median age was 68 year-old (IQR 35–83) and 117 patients were male. Tumor location was Ce:Ut:Mt:Lt:Ae = 1:12:67:58:13. Histologic cell-type was squamous cell carcinoma (SqCC):adenocarcinoma = 142:9. The clinical stage (TNM 8th edition) was I:II:III:IVa = 45:39:56:2 and I:IIB:III:IVA = 2:1:5:1 in patients with SqCC and in those with adenocarcinoma, respectively. R0 resection was performed in all patients. The Clavian-Dindo classification grade III and higher RLN paralysis rate was 7.3% and the pneumonia 5.3%. The mortality rate was 1.3%. Three-year disease free survival rate was 62.3%. Three-year overall survival rate was 71.7%. Conclusion The outcomes of mesenteric excision for esophageal cancer surgery were acceptable. Video https://www.dropbox.com/s/y1lm3uurr4t86vq/2020%20ISDE%20Abstract.mov?dl=0.
Published Version
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