Short-term clinical efficacy of laparo-gastroscopic esophagectomy / 中华消化外科杂志

Objective:To investigate the short-term clinical efficacy of laparo-gastroscopic esophagectomy (LGE).Methods:The retrospective and descriptive study was conducted. The clini-copathological data of 11 patients with esophageal cancer who underwent LGE in the Zhongshan Hospital of Fudan University from June 2020 to October 2021 were collected. There were 8 males and 3 females, aged (68±4)years. Sorted by operation time, the sentinel lymph nodes navigation (SLN) was performed since the sixth patient in the cohort, and abdominal surgery and neck surgery were performed simultaneously to complete LGE. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted using outpatient examination or telephone interview to detect death of patients during postoperative 30 days. Patients were followed up during postoperative 30 days. Measurement data with normal distribution were represented as Mean± SD, and count data were described as absolute numbers. Results:(1) Surgical situations. Of the 11 patients, 5 cases received SLN with satisfactory visualization, 6 cases did not receive SLN, 1 case terminated the operation as sentinel lymph nodes biopsy showing positive results and the rest of 10 cases completed LGE successfully without conversion to thoracotomy. The operation time and tumor diameter of the 10 patients completing LGE was (204±27)minutes and (2.5±1.0)cm, respec-tively. (2) Postoperative situations. Of the 10 patients completing LGE, 2 cases had pulmonary complications after surgery and recovered well with symptomatic treatment, and none of patient had anastomotic leakage or other serious complication. Results of postoperative histopathological examination showed squamous cell carcinoma in the 10 patients completing LGE. Nine patients were classified as T1b?3N0M0 stage and 1 patient was classified as T1bN1M0 stage. Ten patients completing LGE had R 0 resection and the number of lymph nodes dissected was 14±4. There were 3 cases with nerve bundle invasion, 2 cases with vascular invasion and 5 cases without nerve bundle and vascular invasion. The postoperative treatment time at intensive care unit and duration of hospital stay of the 10 patients completing LGE were (4.0±2.4)days and (7.2±1.5)days. (3) Follow-up. The 10 patients completing LGE were followed up and none of them died during the postoperative 30 days. Conclusions:LGE is safe and feasible. Combined with SLN can guarantee the oncology effect of surgery.

Application value of totally laparoscopic transabdominal-hiatal approach in the radical resec-tion of Siewert type Ⅱ adenocarcinoma of esophagogastric junction / 中华消化外科杂志

Objective:To investigate the application value of totally laparoscopic trans-abdominal-hiatal approach in the radical resection of Siewert type Ⅱ adenocarcinoma of esophago-gastric junction (AEG).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 45 patients with Siewert type Ⅱ AEG who were admitted to the Affiliated Hangzhou First People′s Hospital, Zhejiang University School of Medicine from May 2017 to December 2020 were collected. There were 28 males and 17 females, aged from 35 to 85 years, with a median age of 64 years. All patients underwent radical resection of AEG by totally laparoscopic trans-abdominal-hiatal approach with gastrointestinal anastomosis using proximal gastrectomy with double-tract anastomosis or total gastrectomy with esophagojejunointestinal anastomosis and digestive reconstruction using transdiaphragmatic-hiatal superior overlap esophagojejunostomy. Observation indicators: (1) surgical and postoperative situations; (2) postoperative histopathological examination; (3) follow-up and survival situations. Follow-up using outpatient examination and telephone interview was performed to detect survival of patients and tumor recurrence and metastasis up to March 2021. Measurement data with normal distribution were presented as Mean± SD and measure-ment data with skewed distribution were presented as M(range). Results:(1) Surgical and post-operative situations: all 45 patients underwent radical resection of AEG by totally laparoscopic transabdominal-hiatal approach successfully, including 35 cases undergoing total gastrectomy with esophagojejunointestinal anastomosis and 10 cases undergoing proximal gastrectomy with double-tract anastomosis. The total operation time, time of lower mediastinal lymph node dissection, time of superior overlap esophagojejunostomy, volume of intraoperative blood loss, time for initial out-of-bed activities, time to first flatus, time to initial liquid diet intake, time to drainage tube removal of the 45 patients were (235±32)minutes, (25±8)minutes, (45±10)minutes, (70±13)mL, (20±8)hours, (2.3±0.2)days, (2.6±0.8)days and (6.2±1.1)days, respectively. Eleven of 45 patients under-went postoperative complications and none of patient died during perioperative period. The post-operative duration of hospital stay of 45 patients was (10±3)days. (2) Postoperative histopatho-logical examination: all 45 patients had negative upper surgical margin. The length of proximal margin, tumor diameter, total number of lymph lodes harvested and number of lower mediastinal lymph nodes harvested were (2.5±0.5)cm, (2.9±0.8)cm, 35.0±4.0 and 2.4±0.8, respectively. Patholo-gical examination showed adenocarcinoma in all 45 patients with pTNM staging as 5 cases of stage ⅠB, 8 cases of stage ⅡA, 21 cases of stage ⅡB and 11 cases of stage ⅢA. (3) Follow-up and survival situations: 45 patients were followed up for 3 to 46 months, with a median follow-up time of 26 months. During follow-up, 8 of 45 patients died. Of the 37 patients survived, 3 cases underwent liver metastasis and 3 cases underwent bone metastasis, lung metastasis or peritoneal metastasis respec-tively.Conclusion:Total laparoscopic transabdominal-hiatal approach is safe and feasible in the treatment of Siewert type II AEG with a satisfactory clinical efficacy.

Transhiatal oesophagectomy: a single unit study

Background: Oesophageal cancer is a common gastrointestinal malignancy in our country and transhiatal oesopahgectomy is popular choice of surgery for lower oesophageal cancers. This study aims at identifying the feasibility and effectiveness of this surgery in our setting.Methods: This prospective study was performed in Department of Surgery, SDM College of Medical Sciences and Hospital, Dharwad, India. It included a total of 10 cases operated during the study period. Various pre-operative, intra-operative and post-operative parameters were observed and results tabulated.Results: In our study dysphagia (90%) was the most common presenting complaint and tobacco, either smoked (40%) or chewed (40%) formed a common risk factor. Lower oesophageal growths (80%) were more common than mid oesophageal (20%). The preferred incision was midline (80%) and average duration of surgery was 351min and average blood loss was estimated to be 521 ml. There was one mortality and a R0 resection in 90% of the cases with 10% positive for local lymphnodal malignant spread.Conclusions: Our statistics are not very different to the studies compared, and we believe they will only improve. We propose transhiatal oesophagectomy to be a practical and affective tool in a surgeon’s armamentarium, which certainly can be a formidable treatment modality in sub-carinal oesophageal cancer.

Esophagectomy for Cancer of the Esophagus- GMC Jammu Experience

We retrospectively reviewed a data of 202 patients, who underwent esophagectomy for cancer of the esophagusover 12 years at GMC, Jammu. Out of 262 patients, 202 patients underwent esophagectomy, mean age was53 years, ranging between 31-75 years. 160 patients had squamous cell carcinoma and 31 patients hadadenocarcinoma. 148 patients underwent transhiatal esophagectomy (Orringer’s procedure), whereas 18patients underwent McKeown’s three incision procedure and 10 patients underwent transthoracic esophagectomy(Ivor lewis) procedure. It was observed that mid third tumors accounted for 40%, lower third tumorsaccounted for 55 % and GE junction tumors 5% of the cases. Squamous cell carcinoma was the mostcommon histology (79.5 %). The overall morbidity (significant complications leading to prolonged hospitalization)was 38 %. Perioperative mortality was 13(6.43%). We hereby conclude that esophagectomy is a majorsurgical operation and gives palliation of dysphagia to patient and our experience with it has been with acceptablemorbidity and with favorable short-term results.

The Abdominal Approach for Epiphrenic Esophageal Diverticulum as an Alternative to the Thoracic Approach / 대한흉부외과학회지

BACKGROUND: There is no established surgical procedure for the treatment of epiphrenic esophageal diverticulum. The aim of this study was to compare the clinical outcomes of esophageal diverticulectomy using abdominal and thoracic approaches. METHODS: We retrospectively reviewed 30 patients who underwent esophageal diverticulectomy through the thoracic or abdominal approach for an epiphrenic diverticulum at a single center between 1996 and 2018. We compared clinical outcomes, including the postoperative length of stay, time from the operation to oral feeding, leakage rate, and reoperation rate between the 2 groups. RESULTS: The median age was 56 years. Of the 30 patients, 18 (60%) underwent diverticulectomy via the thoracic approach and 12 (40%) underwent the abdominal approach. The median hospital stay was 10 days (range, 5–211 days) in the thoracic approach group and 9.5 days (range, 5–18 days) in the abdominal approach group. The median time from the operation until oral feeding was 6.5 days (range, 3–299 days) when the thoracic approach was used and 5 days (range, 1–11 days) when the abdominal approach was used. In the thoracic approach group, the leakage rate was 16.67% and the reoperation rate was 27.78%. However, there were no cases of leakage or reoperation in the abdominal approach group. CONCLUSION: The abdominal approach for esophageal diverticulectomy is a feasible and appropriate alternative to the thoracic approach.

Diaphragmatic Hernia after Transhiatal Esophagectomy for Esophageal Cancer

Diaphragmatic hernia was found in a patient who had undergone transhiatal esophagectomy for early esophageal cancer. Chest X-ray was not helpful, but abdominal or chest computed tomography was useful for accurate diagnosis. Primary repair through thoracotomy was performed and was found to be feasible and effective. However, long-term follow-up is required because hernia recurrence is common.

Esofagectomía transhiatal y ascenso gástrico en el tratamiento de las neoplasias malignas esofágicas / Transhiatal esophagectomy and gastric elevation in the treatment of malignat neoplasm of esophagus

Se evalúa la esofagectomía transhiatal y el ascenso gástrico como alternativa terapéutica en veintiún pacientes concarcinoma de esófago. La edad promedio fue de 60,52 ± 9,64 años, de los cuales catorce pacientes (66,66%)pertenecieron al sexo masculino y siete pacientes al sexo femenino (33,33%). En los pacientes sometidos a ascensogástrico la complicación peroperatoria más frecuente fue la ruptura unilateral y bilateral de la pleura, y las complicaciones posoperatorias más frecuentes la presencia de estenosis de la anastomosis cervical (23,80%) la fístula cervical (14,28%), con una mortalidad de 19,04% asociadasa complicaciones infecciosas en tres pacientes (14,28%). La esofagectomía transhiatal es una de las técnicas quirúrgicas en el tratamiento de las neoplasias esofágicas; sin embargo, no está exenta de complicaciones tales como estenosis de la anastomosis y fístula cervical, es necesaria una adecuada preparación nutricional preoperatoria para disminuir la presencia de complicaciones posoperatorias

In this study the transhiatal esophagectomy is evaluated as therapeutic alternative in twenty-one patients with esophagus carcinoma. The average age of the patients was 60,52 ± 9,64 years, fourteen patients (66.66%) were male and seven patients female. In the patients with transhiatal esophagectomy the peroperative complication more frequent was the unilateral and bilateral rupture of the pleura, and the most frequent postoperatory complications was the cervical anastomosis stenosis (23.80%) and the cervical leakage (14.28%), with a mortality of 19.04%associated with infectious complications in three patients (14.28%). The transhiatal esophagectomy is one of the surgical procedures in the treatment esophageal neoplasm but is important consider the possibility of complications as cervical stenosis and cervical leakage and is necessary and adequate nutritional preoperative preparation to avoid complications as cervical stenosis and anastomosis leakage and is required an adequate preoperatory preparation to reduce the incidence of postoperative complications

Estenosis esofágica por ingestión de cáusticos / Esophageal stenosis due to caustic ingestion

RESUMEN Las sustancias químicas son causas importantes de lesiones del tracto gastrointestinal y suelen afectar dos grupos de pacientes: los niños menores de 5 años y los adultos que intentan el suicidio. La principal complicación de la ingesta accidental de cáusticos es la estenosis esofágica. Diferentes formas de tratamiento se han aplicado para tratar las estenosis esofágicas por cáusticos y en primera línea está la dilatación endoscópica, con resultados exitosos en el 60 a 80% de los pacientes. Si estas no son efectivas, se indica el tratamiento quirúrgico de reemplazo esofágico, y entre las técnicas más frecuentes destaca la esofagectomía de dos vías de Ivor Lewis y la esofagectomía transhiatal. Se presenta el caso de un paciente del sexo masculino de 20 años de edad que consultó en el Departamento de Cirugía por cuadro de dificultad para la deglución, con el antecedente de ingestión accidental de soda caústica 2 meses antes. Con estudios imagenológicos y endoscópicos se confirmó el diagnóstico de estenosis esofágica por ingestión de cáusticos. Se le realizó una esofagectomía transhiatal asociado a una yeyunostomía de alimentación. La complicación presentada fue neumotórax bilateral en post operatorio, el cualfue resuelto con tubo de drenaje pleural sellado bajo agua. Se indicó el alta hospitalaria en su 15 día de postoperatorio, con buena tolerancia oral.

ABSTRACT Chemicals are important causes of gastrointestinal tract lesions and usually involve two groups of patients: children under 5 years and adults who attempt suicide. The main complication of accidental ingestion is caustic esophageal stricture. Different forms of treatment have been used to treat esophageal stricture and on the frontline is the endoscopic dilation, with successful results in 60 to 80% of patients. If these are not effective, surgical treatment is indicated with esophageal replacement and the most common techniques are the two-way Ivor Lewis esophagectomy and transhiatal esophagectomy. We present a case of a male patient, aged 20 years, consulting in the Department of Surgery with difficulty to swallowing, with a history of accidental ingestion of caustic soda 2 months before. Imaging and endoscopic studies confirmed the diagnosis of esophageal stenosis of caustic ingestion. He underwent a transhiatal esophagectomy associated with a feeding jejunostomy. The complication was bilateral pneumothorax presented in the postoparative time, which was resolved with pleural drainage tube sealed under water. He was discharged from hospital in 15 days after surgery, with good oral tolerance.

Transhiatal Esophagectomy in Cardia and Esophageal Cancer

PURPOSE: The debate is still on-going as to whether a transthoracic esophagectomy (TTE) or a transhiatal esophagectomy (THE) is the proper treatment for patients with cardia and esophageal cancers. This study tries to demonstrate and assess the efficacy and the validity of both surgeries. MATERIALS AND METHODS: In a retrospective study, data from 52 cases of patients with esophageal and/or cardia cancer who received a surgical operation during the last decade were analyzed. RESULTS: A TTE was done in 20 cases and a THE in 32 cases. The average times for the operations were 558.0 min for a TTE and 451.7 min for a THE (P>0.05). The estimated blood loss was 1,825.0 ml in a TTE and 1459.4 ml in a THE (P>0.05). The amounts of transfusion during the operations were 3.9 units in a TTE and 2.6 units in a THE (P0.05). CONCLUSION: For most factors, including morbidity and mortality, there was no statistically significant difference between a TTE and a THE. However, a THE is expected to be more convenient, leading to a shorter operative duration, a shorter post-operative hospitalization and lesser amounts of hemorrhage and transfusion. Hence, the THE may be a more valid or efficient surgical method for those patients with cardia and esophagus cancer who require a resection of the esophagus.

On the safety of video-assisted mediastinoscopic esophagectomy / 中国微创外科杂志

0 05) between the two procedures in incidence of anastomotic leakage (25 0% vs 10 7%), pulmonary infection rate (31 3% vs 32 1%), incide nce of thoracic cavity infection (0 vs 3 6%), proportion of re-thoracotomy (0 vs 3 6%), incidence of d elayed gastric emptying (3 1% vs 21 4%), postoperative SICU stay (4d?2 3d vs 5d ?3 6d), and peri-operative mortality (3 1% vs 7 1%). The incidence of recurr ent laryngeal nerve injuries (28 1% vs 7 1%, ? 2=4 391,P =0 036) and arr hythmia (43 8 % vs 17 9%, ? 2 =4 627, P =0 031) in the THE Group were significantly higher than those in the TTE Group, while the intra-operative blood loss in the THE Group was signif icantly less than that in the TTE Group ( t = -3 100, P =0 003).ConclusionsVideo- assisted THE is a safe procedure. With the increase of the experience, the incid ence of post- operative complications is subject to further decrease.

Reconstruction Using Stomach after Resection of Hypopharynx and Esophagus

PURPOSE: This study sought to evaluate the treatment modality, morbidity and mortality after surgery, the method of nutritional support and the survival rate for patients with cancer of the hypopharynx, larynx and cervical esophagus. METHODS: A retrospective review was undertaken of 17 hypopharyngeal, laryngeal and cervical esophageal carcinoma patients who had undergone surgical treatment in the Department of Surgery and Otorhinolaryngology, Yonsei University, College of Medicine, from January 1995 to April 2000. All patients underwent transhiatal esophagectomy in order to avoid pulmonary complications. Outcome measures were calculated using the Kaplan-Meier estimator. RESULTS: The 17 consecutive patients included 11 cases of hypopharyngeal cancer, 3 glottic cancers, 2 cervical esophageal cancers and one thyroid cancer with invasion of the trachea and esophagus. Fifteen patients (88%) presented with an advanced tumor stage. As for nutritional support following surgery, 12 underwent feeding jejunostomy, 4 a nasoenteric tube feeding and the other recieved total parenteral nutrition. Nine patients (53%) developed complications following surgery. One of the patients who had surgery died postoperatively. The mean survival time was 26 months and the 2-year and 4-year overall survival rates were 69.5% and 53.0%, respectively. CONCLUSION: Reconstruction of the hypopharynx and esophagus using stomach was low mortality and low severe morbidity. A total pharyngolaryngoesophagectomy with gastric transposition and primary hypopharyngogastric anastomosis offers the best chance for cure or palliation with acceptable morbidity and degree of function for selected patients with advanced hypopharyngeal, laryngeal and cervical esophageal carcinomas.

Transhiatal Esophagectomy Using Laparoscope in Esophageal Cancer / 대한암학회지

PURPOSE: To remove the tumor and to restore continuity is very important in patients with esophageal cancer for cure of disease or palliation. To compare the outcome of Transhiatal Esophagectomy using Laparoscope (Lapa-THE), author`s modification of traditional tanshiatal esophagectomy, with that of transhiatal esophagectomy (THE). MATERIALS AND METHODS: The author performed THE in 10 cases with esophageal cancer and Lapa-THE in 5 cases with esophageal cancer from March 1992 to August 1996 in Department of Surgery, Pusan National University Hospital. RESULTS: Of all 15 cases with esophageal cancer, 6 cases were occurred at 6th decade and 3 cases were occurred at 7th decade. The ratio of male to female was 4:1. The all 5 cases with Lapa-THE were mid-thoracic esophageal cancers. Of 10 cases with THE, the cancer occurred 2 cases in mid-thoracic esophagus, 4 cases in lower-thoracic esophagus and 4 cases in cardia portin. According to pathological type, the 12 cases were squamous cell carcinoma, 2 cases were adenocarcinoma, and 1 case was small cell carcinoma. Of all 10 cases with THE, the postoperative death was occurred in 1 case due to graft necrosis, other postoperative complications were occured in 5 cases, stenosis of anastomotic site in 3 cases, wound infection in 1 case and pleural effusion in 1case. In the cases with Lapa-THE, stenosis was occurred in 1 case, wound infection in 1 case and there was no postoperative death. CONCLUSION: The Lapa-THE is comparable therapeutic technique with conventional THE for treatment of patient with esophsgeal cancer, especially it was useful in mid-thoracic esophageal cancer.

Esophageal Replacement with Transhiatal Gastric Transposition in the Long Gap Esophageal Atresia

Transhiatal gastric transpositions were performed in two case of long gap esophageal atresia without tracheoesophageal fistula. The patients were a 12 months old female and an 18 months old male. Stamm type gastrostomies were performed at other hospitals in both cases. The stomach was mobilized preserving the right gastric artery, the right gastroepiploic artery and spleen. The proximal and distal esophageal pouches were excised by transcervical and transhiatal route, respectively. The mobilized stomach was pulled up to the neck through esophageal hiatus and posterior mediastinal route. The esophagogastrostomy, the only one anastomosis of this procedure, was performed in the neck. There was no clinical evidence of anastomotic leakage, stricture, regurgitation, difficulty of gastric emptying, hoarseness or respiratory problem. Transhiatal gastric transposition seems to be a safe and easy alternative surgical procedure for esophageal replacement in long gap esophageal atresia.

Transhiatal gastric transposition of a long gap esophageal atresia

Transhiatal gastric transposition was performed in a long gap esophageal atresia without tracheoesophageal fistula. The patient was a 12 months old female infant with previous stamm-type gastrostomy. The stomach was mobilized preserving the right gastric artery, the right gastroepiploic artery and spleen. The proximal and distal blind pouches of esophagus were excised by transcervical and transhiatal route, respectively. The mobilized stomach was pulled up into the neck through esophageal hiatus and posterior mediastinal route. The esophagogastrostomy, the only one anastomosis of this procedure, was safely performed in the neck. There were neither anastomotic leak nor early anastomotic stricture. The oral feeding was quickly established. There was no clinical evidence of regurgitation, difficulty of gastric emptying, hoarseness or respiratory problem. The low morbidity combined with satisfactory functional result indicates that the transhiatal gastric transposition is a safe and easy alternative surgical procedure for esophageal replacement in long gap esophageal atresia.