Contemporary Role of Open Left Thoracoabdominal Approach in Esophageal Malignancy Treatment.

INTRODUCTION: Despite the widespread use of minimally invasive techniques, open left thoracoabdominal esophagectomy (LTE) can offer excellent visualization and adaptability. The current study aimed to present and evaluate the outcomes related to an open LTE in esophageal malignancy treatment. METHODS: A retrospective cohort analysis of data collected from two institutions was performed, including patients with distal esophageal or junctional tumors who underwent open LTE between November 2018 and December 2023. RESULTS: Twenty-two patients were included (16 males; mean age 62.8 years). Postoperative complications occurred in eight patients (36%), with pulmonary complications being the most prevalent (seven patients; 32%). One patient experienced a clinical anastomotic leak. No reoperations or escalation to a higher level of care were required. In-hospital and 30-day mortality were zero. Tumor cells were found at the surgical margins in six patients (27%). The mean lymph node yield was 27. During the follow-up period, there were nine deaths and 11 cases of disease recurrence. Isolated locoregional recurrence was seen in five patients (23%). The one-year and two-year overall survival rates were 79% and 47%, respectively. CONCLUSION: In selected cases, open LTE remains a valid and safe operation with acceptable morbidity and oncological efficacy.

Perineal sepsis and successful surgical treatment in supralevator and ischiorectal fossa abscess: a case report.

A male 61-year-old patient presented to the emergency department with fever, leukocytosis and perineal pain. Macroscopic examination of anogluteal region demonstrated a bulky inflamed mass in the left ischiorectal fossa with a skin defect draining large amounts of pus. The suprapubic area was observed to be erythematous, with local tenderness and a palpable inflammatory mass under the skin. Computed tomography and magnetic resonance imaging revealed an abscess of the ischiorectal fossa and concomitant supralevator abscess. Examination under anesthesia revealed an internal fistula at the posterior dentate line, with pus emanating from the orifice. A bulging mass was found, protruding in the left lateral and inferior area of the rectal ampulla, a finding compatible with the supralevator abscess identified by imaging. Drainage of the abscess into ischiorectal fossa, supralevator space and suprapubic area was successful with a prompt improvement in the clinical and laboratory profile of the patient.