PS02.003: SINGLE INCISION TRANSCERVICAL MEDIASTINOSCOPIC LYMPHADENECTOMY FOR ESOPHAGEAL CANCER

Abstract

Abstract Background A transhiatal approach in esophageal cancer surgery has limitation for mediastinal lymph node dissection compared with thransthoracic approach for esophageal cancer. Because of insufficient lymph node clearance, single incision mediastinoscopic surgery is an one of the minimally invasive surgical option for esophageal cancer. Herein, we introduce our initial experience with use of the procedure in 3 patients with esophageal cancer Methods We retrospectively collected data from 3 patients who diagnosed with esophageal cancer and who underwent 3 field transmediastinal radical esophagectomy (TMRE) between Jun 2016 and December 2017. TMRE was performed in old age patients (> 75 years) and patients with limited cardiopulmonary reserve in whom thransthoracic approach could not be used. After the left cervical incision and cervical lymphadenectomy, a single port was inserted into the wound. Esophageal mobilization with en bloc lymphadenectomy along the left and right recurrent laryngeal nerve was then performed. Carbon dioxide insufflation expanded the intramediastinal space, and deep mediastinal structures were clearly visualized, allowing lymphadenectomy to be safely and carefully performed along the nerves. Laparoscopic transhiatal esophagectomy was then performed with en bloc lymphadenectomy for lower and/or middle mediastinal nodes. Results The mean age was 75.5 ± 3.5. Among the 3 patients, two patients had severe cardiopulmonary dysfunction. The mean operation time in transmediastinal approach and transhiatal approach were 202.0 ± 18.0 and 350.0 ± 27.8, respectively. The mean retrieval number of mediastinal lymph node was 39.0 ± 5.3. There were no severe postoperative complications and there was no postoperative mortality. Mild pleural effusion was occurred in only one patient. Conclusion TMRE with single incision mediastinoscopic approach was technically feasible and oncologically safe procedure for esophageal cancer, especially in patients with old age or with limited cardiopulmonary reserve. Disclosure All authors have declared no conflicts of interest.