Totally laparoscopic plus one transthoracic port esophagogastrectomy for Siewert-type Ⅱ adenocarcinoma of esophagogastric junction.

Abstract

e16568 Background: The incidence of Siewert type Ⅱ adenocarcinoma of esophagogastric junction (AEG) is increasing, especially in Asia, but laparoscopic surgery for type Ⅱ AEG is not widely accepted due to the technical challenges and unknown prognosis. To address this problem, we developed a novel technique of totally laparoscopic plus one transthoracic port esophagogastrectomy. Methods: From May 2017 to December 2019, 24 patients with advanced Siewert type Ⅱ AEG underwent the procedure. The surgical technique is that after completely abdominal lymphadenectomy and mobilization of the stomach laparoscopically, the left diaphragm was incised 5 to 7 cm, followed by one transthoracic port was inserted into the thoracic cavity through the left axillary frontline at the sixth to eighth intercostal spaces. Then lower mediastinal lymphadenectomy and transection of the lower esophagus were completed through the transthoracic supplementary port. An intrathoracic Roux-en-Y esophagojejunostomy was performed also through this port, which was finally used for thoracic drainage. Results: All procedures containing 5 proximal gastrectomies and 19 total gastrectomies were completed successfully without surgical morbidity and mortality. The median operative time was 344 (205 to 540) min. The time for reconstruction was 38 (25 to 60) min. The median blood loss was 100 (20 to 300) ml. The median tumor diameter was 3.8 (1.5 to 6.7) cm with a median esophagus invasion of 2.5 (0.6 to 4.5) cm. The median number of lymph nodes harvest was 37 (18 to 60). The median number of lower mediastinal lymph nodes was 5 (1 to 13) and its metastasis rate was 33.3%(8/24). The median time of first flatus was 4 (2 to 7) days. The median hospital stay was 11 (7 to 45) days. One patient developed a thoracic infection and one esophagojejunostomy leakage, both cured with thoracic drainage and antibiotic treatment. The median follow-up was 22(1-32). The DFS was 83.3% and OS was 91.7%. Conclusions: Our initial result suggested that this novel technique was safe and feasible for Siewert type Ⅱ AEG, associated with the advantages of complete lower mediastinal lymphadenectomy and easy intrathoracic Roux-en-Y esophagojejunostomy by using the transthoracic assisted port.