Middle and lower esophagectomy preceded by hand‑assisted laparoscopic transhiatal approach for distal esophageal cancer

Shiozaki,Atsushi; Fujiwara,Hitoshi; Konishi,Hirotaka; Morimura,Ryo; Komatsu,Shuhei; Murayama,Yasutoshi; Kuriu,Yoshiaki; Ikoma,Hisashi; Kubota,Takeshi; Nakanishi,Masayoshi; Ichikawa,Daisuke; Okamoto,Kazuma; Sakakura,Chouhei; Otsuji,Eigo

doi:10.3892/mco.2013.201

January-February 2014 Volume 2 Issue 1

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January-February 2014 Volume 2 Issue 1

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Article

Middle and lower esophagectomy preceded by hand‑assisted laparoscopic transhiatal approach for distal esophageal cancer

Authors:
- Atsushi Shiozaki
- Hitoshi Fujiwara
- Hirotaka Konishi
- Ryo Morimura
- Shuhei Komatsu
- Yasutoshi Murayama
- Yoshiaki Kuriu
- Hisashi Ikoma
- Takeshi Kubota
- Masayoshi Nakanishi
- Daisuke Ichikawa
- Kazuma Okamoto
- Chouhei Sakakura
- Eigo Otsuji
View Affiliations / Copyright

Affiliations: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602‑8566, Japan
Pages: 31-37
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Published online on: October 17, 2013

https://doi.org/10.3892/mco.2013.201
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Abstract

Respiratory morbidity is the most frequent complication following an esophagectomy. This study was designed to determine the efficacy of middle and lower esophagectomies preceded by the hand‑assisted laparoscopic transhiatal approach (LTHA) regarding the perioperative outcomes of distal esophageal cancer. The esophageal hiatus was opened and carbon dioxide was introduced into the mediastinum. Dissection of the distal esophagus was performed up to the level of the tracheal bifurcation. En bloc dissection of the posterior mediastinal lymph nodes was performed using the LTHA. Subsequently, a small thoracotomy (10 cm) was performed to divide the thoracic esophagus and allow middle mediastinal lymphadenectomy. Finally, reconstruction via the posterior mediastinal route with a gastric tube and anastomosis in the thoracic cavity were performed using a circular stapler. The treatment outcomes of 10 patients who underwent LTHA‑preceded middle and lower esophagectomy were compared to those of 11 patients treated without prior LTHA (thoracotomy, 20 cm). The total operative time, the duration of one‑lung ventilation and total operative blood loss were significantly decreased in the LTHA group. The number of resected lymph nodes did not differ significantly between the two groups. Postoperative respiratory complications occurred in 10.0% of patients treated with, and 36.3% of those treated without LTHA. The extubation time following surgery, the duration of thoracic drainage and postoperative hospital stay were significantly decreased by this method. In conclusion, middle and lower esophagectomies preceded by LTHA provides a good surgical view of the posterior mediastinum, markedly shortens the duration of one‑lung ventilation and improves the perioperative outcome.

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Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Middle and lower esophagectomy preceded by hand‑assisted laparoscopic transhiatal approach for distal esophageal cancer

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Abstract

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