Abstract
Objective:Minimally invasive esophagectomy (MIE) is increasingly used for the treatment of esophageal cancer. However, MIE via the Sweet approach has seldom been reported owing to the challenging procedure for a mediastinal lymph node. Thus, the approach of MIE via left-sided thoracoscopy coupled with video-assisted cervical mediastinoscopy (MIE-SM) was explored for eradicating the mediastinal lymph nodes and recurrent laryngeal nerve; the incidence of perioperative complications, mortality, and surgical radicality were analyzed.Materials and Methods:Thirty patients with esophageal carcinoma underwent MIE-SM between June 2014 and February 2016. The primary outcome was postoperative morbidity within 2 weeks postsurgery. The secondary outcome was surgical radicality, including the circumferential margins, and the number of lymph nodes dissected.Results:The MIE-SM was completed in all patients within 367.6±68.7 minutes. The incidences of postoperative morbidities including pulmonary complications, anastomotic leakage, chylothorax, or recurrent nerve injury were 43.3%.Conclusion:The MIE-SM was utilized for the first time to reduce the disadvantage of purely Sweet and McKeown approach, with favorable efficacy in the mediastinal and laryngeal recurrent nerve lymph node eradication. Thus, MIE-SM might be a promising alternative approach in treating esophageal cancer in selected patients.
Highlights
The present study performed Minimally invasive esophagectomy (MIE) via the Sweet approach coupled with cervical mediastinoscopy (MIE-SM) in patients with esophageal squamous cell cancer that was localized in the middle and lower third of the thoracic esophagus at a high-volume cancer center
The current study has revealed several advantages of MIE-SM over the conventional open procedure
The present study indicated that patients might benefit from MIE-SM esophagectomy; a prospective randomized clinical trial comparing the short-term morbidity and long-term outcomes between MIE-SM and other operation is essential
Summary
Invasive esophagectomy (MIE) is increasingly used for the treatment of esophageal cancer. The approach of MIE via left-sided thoracoscopy coupled with video-assisted cervical mediastinoscopy (MIE-SM) was explored for eradicating the mediastinal lymph nodes and recurrent laryngeal nerve; the incidence of perioperative complications, mortality, and surgical radicality were analyzed. Conclusion: The MIE-SM was utilized for the first time to reduce the disadvantage of purely Sweet and McKeown approach, with favorable efficacy in the mediastinal and laryngeal recurrent nerve lymph node eradication. Ivor-Lewis esophagectomy (right-sided thoracotomy) offers superior visualization of the upper mediastinum and allows extended lymphadenectomy; it is performed less frequently owing to a frequent association with high postoperative morbidity, excessive blood loss, and prolonged surgical duration and hospital stay[2,3]. The present study performed MIE via the Sweet approach coupled with cervical mediastinoscopy (MIE-SM) in patients with esophageal squamous cell cancer that was localized in the middle and lower third of the thoracic esophagus at a high-volume cancer center. We assessed the incidence of perioperative complications, mortality, and surgical radicality
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