Mediastinoscopy-assisted esophagectomy for esophageal cancer in patients with serious comorbidities

Koide, Naoki; Takeuchi, Daisuke; Suzuki, Akira; Miyagawa, Shinichi

doi:10.1007/s00595-011-0042-3

Cited by 19 publications

(17 citation statements)

References 36 publications

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“…In 2015, the Japanese scholar Hitoshi Fujiwara systematically reported a method of cervical mediastinoscopy combined with laparoscopic esophagectomy; since then, this procedure has been gradually applied worldwide (4,5). Some retrospective studies have shown that compared to TLE, MATHE further reduces surgical trauma, and it seems to be more advantageous in protecting respiratory function (6)(7)(8). However, there are currently no multicenter randomized controlled studies comparing MATHE with TLE for esophageal cancer.…”

Section: Introductionmentioning

confidence: 99%

Mediastinoscopy-assisted transhiatal esophagectomy versus thoraco-laparoscopic esophagectomy for esophageal cancer: a single-center initial experience

et al. 2020

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Background: We aimed to compare mediastinoscopy-assisted transhiatal esophagectomy (MATHE) with thoraco-laparoscopic esophagectomy (TLE) for patients with esophageal cancer in terms of the clinical effectiveness and perioperative complications. Methods: In total, 98 patients who underwent esophagectomy consecutively for esophageal squamous cell carcinoma in our center from Jan. 2018 to Dec. 2019 were included in this study. Thirty patients underwent mediastinoscopy-assisted and laparoscopic transhiatal esophagectomy with cervical anastomosis (the MATHE group). The other sixty-eight patients received TLE (the TLE group). Each patient's general conditions and perioperative complications were recorded. Results: Patients in the MATHE group were observed to have a higher incidence of postoperative hoarseness than those in the TLE group. There were no significant differences between the MATHE group and the TLE group in regards to the operation time, intraoperative blood loss, number of lymph nodes dissected or postoperative hospital stay. Similarly, no statistically significant differences were observed in the incidence of anastomotic fistula, respiratory complications, or chylothorax or in the conversion rate or inhospital mortality rate between the two groups. Conclusions: The short-term efficacy in the MATHE group was similar to that in the TLE group, although patients in the MATHE group may have had a higher incidence of postoperative hoarseness. Therefore, MATHE may be a feasible and safe surgical procedure for appropriate patients with esophageal cancer.

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Section: Introductionmentioning

confidence: 99%

Mediastinoscopy-assisted transhiatal esophagectomy versus thoraco-laparoscopic esophagectomy for esophageal cancer: a single-center initial experience

et al. 2020

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“…So far, the indications and contraindications for the MAE are still controversial, and there is no comprehensive and recognized standard. Many comparative studies have demonstrated the feasibility of MAE, and in the course of long-term follow-up, the treatment effect is similar to transthoracic esophagectomy [ 2 , 16 , 17 ]. MAE avoids transthoracic operations, and it can be considered as a more friendly technique for patients with poor cardiac and pulmonary function, or a history of pleural disease [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

The application of rigid and flexible mediastinoscopy in esophagectomy: our experience and a new technology

Dong

et al. 2021

World J Surg Onc

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Background To avoid the inconvenience of triangulation among various rigid operating instruments in mediastinoscopy-assisted esophagectomy, we invented a new technique: used a flexible endoscope to mobilize thoracic esophagus and dissected mediastinal lymph nodes through the left cervical incision. This technology has not been reported so far. In this study, we introduce our long-term experience and demonstrate this new technique. Methods Twenty-nine patients with early esophageal cancer underwent mediastinoscopy-assisted esophagectomy in our hospital from June 2018 to September 2020. Among them, 12 patients used flexible mediastinoscopy, and 17 patients used conventional rigid mediastinoscopy and instruments to observe their therapeutic effect. Results There were no significant differences between the two groups in gender, average age, body mass index, incidence of adverse reactions, bleeding volume, and postoperative hospital stay. The operation time of flexible mediastinoscopy group was significantly shorter than that of rigid mediastinoscopy group (192.9 ± 13.0 vs 246.8 ± 6.9 min, p < 0.01). The number of lymph nodes removed by flexible endoscopy was significantly more than that of rigid endoscopy (8.5 ± 0.6 vs 6.0 ± 0.3, P < 0.01). Postoperative follow-up was completed for all patients, and the average follow-up time was 11.6 ± 7.2 months. During the follow-up period, no recurrence or death was observed. Conclusions Mediastinoscopy-assisted esophagectomy is an effective way to treat early esophageal cancer. The application of flexible mediastinoscopy provides more convenience and better stability. It can facilitate the operation of the surgeon and lymph node dissection, which proved to be a feasible technology.

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“…For esophageal cancer, mediastinoscopy was introduced into THE to improve visibility and handling in transcervical procedures; it enables safe esophageal dissection with lymph node sampling without any blind dissection. Since the first report by Bumm et al in 1993, which referred to the method as “endodissection of the thoracic esophagus,” there have been a limited number of reports of THE with mediastinoscopic assistance, initially from Europe and, since 2004, from Japan and China . In 2004, Tangoku et al reported on the short‐term outcomes of mediastinoscopy‐assisted THE, often abbreviated as MATHE, using a compact mediastinoscope designed for Japanese patients …”

Section: Mediastinoscopy‐assisted Thementioning

confidence: 99%

“…Since the first report by Bumm et al in 1993, (23) which referred to the method as "endodissection of the thoracic esophagus," there have been a limited number of reports of THE with mediastinoscopic assistance, initially from Europe and, since 2004, from Japan and China. (9,10,(23)(24)(25)(26)(27)(28)(29)(30) In 2004, Tangoku et al reported on the short-term outcomes of mediastinoscopy-assisted THE, often abbreviated as MATHE, using a compact mediastinoscope designed for Japanese patients. (9) Mediastinoscopy-assisted THE has been generally indicated as radical surgery for distal and junction tumors in Western countries (23)(24)(25) and as a less radical or limited surgery for clinical T1-2 or stage I-II tumors in any location in ESCC patients at high-risk for thoracotomy in Asia.…”

Section: Mediastinoscopy-assisted Thementioning

confidence: 99%

“…(9) Mediastinoscopy-assisted THE has been generally indicated as radical surgery for distal and junction tumors in Western countries (23)(24)(25) and as a less radical or limited surgery for clinical T1-2 or stage I-II tumors in any location in ESCC patients at high-risk for thoracotomy in Asia. (9,10,(26)(27)(28)(29)(30) Most reports are on the short-term outcomes, particularly safety and feasibility.…”

Section: Mediastinoscopy-assisted Thementioning

confidence: 99%

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Transmediastinal approach for esophageal cancer: A new trend toward radical surgery

Fujiwara

Shiozaki

Konishi

et al. 2019

Asian J Endoscop Surgery

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Esophageal squamous cell carcinoma (ESCC), the most common histology of esophageal cancer in Japan and Asia, shows extensive mediastinal spread from an early stage. Therefore, transthoracic esophagectomy with extensive mediastinal lymphadenectomy, including in the upper mediastinum along the recurrent laryngeal nerves, is the gold standard of radical surgery for ESCC. Minimally invasive thoracoscopic esophagectomy has now become a standard option for ESCC. However, transhiatal esophagectomy is regarded as less invasive because it avoids thoracotomy. Yet, it is also considered less curative because it offers a limited surgical view and insufficient mediastinal lymphadenectomy even when conventional specialized mediastinoscopy is used. Recent clinical studies on radical esophagectomy without thoracotomy for ESCC have been reported from Japan. The introduction of novel minimally invasive techniques for the transcervical or transhiatal approach, such as single‐port or robotic surgical devices, have enabled transmediastinal radical esophagectomy for ESCC. This review focuses on the transmediastinal approach for esophageal cancer surgery, which employs minimally invasive techniques to reduce morbidity, and its application to radical surgery for ESCC.

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Mediastinoscopy-assisted esophagectomy for esophageal cancer in patients with serious comorbidities

Abstract: MAE is feasible for esophageal cancer patients with serious comorbidities and may decrease morbidity and mortality.

Cited by 19 publications

References 36 publications

Mediastinoscopy-assisted transhiatal esophagectomy versus thoraco-laparoscopic esophagectomy for esophageal cancer: a single-center initial experience

Mediastinoscopy-assisted transhiatal esophagectomy versus thoraco-laparoscopic esophagectomy for esophageal cancer: a single-center initial experience

The application of rigid and flexible mediastinoscopy in esophagectomy: our experience and a new technology

Transmediastinal approach for esophageal cancer: A new trend toward radical surgery

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