PS01.221: IMPROVED TECHNIQUES AND TREATMENT OUTCOMES IN SINGLE-PORT MEDIASTINOSCOPIC RADICAL ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

Abstract

Abstract Background We have improved the transcervical procedures for radical esophagectomy without thoracotomy for esophageal cancer since 2014, based on the excellent handling and visibility in the deep mediastinum provided by single-port mediastinoscopic technique. This study was to present our latest procedures of single-port mediastinoscopic radical esophagectomy and treatment outcomes for esophageal cancer. Methods (Surgical procedure) First, en bloc lymphadenectomy in the upper and middle mediastinum was performed including the lymph nodes along the left recurrent laryngeal nerve and tracheal bifurcation (subcarinal and bilateral main bronchial lymph nodes) by using a left cervical approach with a single-port mediastinoscopic technique, then, the lymph nodes along the right recurrent laryngeal nerve was done under direct vision by using a right cervical approach. Following the cervical procedures, the esophagus was completely mobilized with en bloc lymphadenectomy in the lower mediastinum by using a laparoscopic transhiatal approach. Finally, the cervical esophagus was transected, and the esophagus was resected through the abdominal incision. This operation was indicated not only for the patients with clinical T1–2 tumors, but also for those with clinical T3 tumors which showed a good response to preoperative chemotherapy. The perioperative outcomes of 111 patients who underwent this operation were reviewed. In addition, overall survival was analyzed and compared between transthoracic and transmediastinal esophagectomy groups (TTE, n = 177 vs. TME, n = 131). Results The background characteristics were as follows; squamous/adeno, 106/5; Ce/Ut/Mt/Lt/Ae, 2/20/58/26/5; cT1–2/T3, 51/60; cN0/N1–2, 53/58; cM0/M1lym, 104/7; cStage I-II/III-IV, 62/49 (TNM7th); preoperative chemotherapy (yes/no), 64/47. The operation time and blood loss were 370 min and 205 ml (median), respectively, and R0 resection rates were 97.3%. Postoperatively, pneumonia was observed in 8 patients (7.2%, C-D grade II or more), while vocal cord palsy was detected in 33 patients (29.7%, C-D grade I or more). Recent introduction of intraoperative nerve monitoring with NIM response 3.0 significantly reduced the palsy in laryngoscopic findings. Overall survival was not significantly different in each clinical stage between TTE and TME groups. Conclusion Single-port mediastinoscopic esophagectomy is feasible as a radical and minimally invasive option for esophageal cancer. Disclosure All authors have declared no conflicts of interest.