Video-assisted thoracoscopic esophagectomy and radical lymph node dissection for esophageal cancer

Osugi, Harushi; Takemura, Masashi; Higashino, Masayuki; Takada, Nobuyasu; Lee, S.; Ueno, Masaki; Tanaka, Yoïchi; Fukuhara, Kennichirou; Hashimoto, Yusuke; Fujiwara, Yushi; Kinoshita, Hiroaki

doi:10.1007/s00464-002-9019-z

Cited by 66 publications

(78 citation statements)

References 17 publications

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“…We also used special instruments, including retractor, scissors, and forceps, optimized for VATS by the supervisor. 19 The initial problem when performing VATS involved ensuring an adequate operative view by the assistant and scopist, and manipulation of instruments. Sometimes we had difficulty obtaining good eye.hand coordination and in appreciating the mediastinal anatomy under the magnifying effect of the thoracoscope.…”

Section: Discussionmentioning

confidence: 99%

“…The reasons for operative conversions were as follows: pleural adhesion in one, undissectable lymph node spread in one, and contiguous tumor spread in two patients. as the site of the minithoracotomy and trocar insertion were the same as described by Osugi et al 19 The right lung was deflated and anteriorly displaced by gentle compression with the retractor. Lung retraction and a 30° telescope made it possible to observe the entire mediastinum.…”

Section: Patientsmentioning

confidence: 99%

“…Esophageal mobilization and mediastinal lymph node dissection were performed under the director's instruction in the initial eight cases in group A, as described previously. 19 The mediastinal lymph nodes were dissected carefully by utilizing the magnifying effect of the video while keeping the camera in close proximity and at an adequate angle to the dissection area. In particular, the lymph nodes around the bilateral recurrent laryngeal nerves were completely For the second stage, the patients were placed in the supine position.…”

Section: Patientsmentioning

confidence: 99%

“…[15][16][17][18] Osugi, who performed more than 200 open esophagectomies, reported that he acquired the basic skills for VATS during his first 17 cases, but that a plateau in his technique had not been reached until 34 cases had been performed. 19 In addition, lethal complications had been found from reports involving surgeons with limited experience. 9,10 These previous reports demonstrated the difficulty and danger during VATS induction, especially for centers performing small numbers of esophageal surgery cases.…”

Section: Introductionmentioning

confidence: 99%

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Results of video-assisted thoracoscopic surgery for esophageal cancer during the induction period

Ninomiya

Osugi

Fujimura

et al. 2008

Gen Thorac Cardiovasc Surg

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Objective. The attainment of proficiency in thoracoscopic radical esophagectomy for thoracic esophageal cancer requires much experience. We aimed to master this procedure safely with our regular surgical team members under the direction of an experienced surgeon. We evaluated the efficacy of instruction during the induction period and the significance of our results.Methods. We compared the results of 12 thoracic esophageal cancer patients who underwent thoracoscopic radical esophagectomy in our institution (group A) to those of the initial 17 patients who underwent the same operation at the director's institution (group B).Results. We were able to perform complete thoracoscopic radical esophagectomies without any direction after experiencing 10 cases that were performed under adequate direction. The number of dissected lymph nodes and the duration of the procedure were similar in the two groups: 34 (22.53) vs. 26 (9.55) nodes, P = 0.23; and 327.5 (110.2360) g, P = 0.0035. Postoperative pneumonia and atelectasis were observed in 25.0% of group A patients and in 17.6% of group B patients. The incidence of recurrent nerve palsy was 30.7% in group A and 11.7% in group B, but there was no statistically significant difference (P = 0.19). The morbidity rates in group A and group B were 41.6% and 29.4%, respectively (P = 0.694).Conclusion. Thoracoscopic radical esophagectomy can be mastered relatively quickly and safely under the direction of an experienced surgeon and a regular surgical team.

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Section: Discussionmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Results of video-assisted thoracoscopic surgery for esophageal cancer during the induction period

Ninomiya

Osugi

Fujimura

et al. 2008

Gen Thorac Cardiovasc Surg

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“…Progress has been made in the surgical technique of esophagectomy and its surgical mortality has drastically decreased 1, 2, 3. Minimally invasive esophagectomy such as video‐assisted surgery can reduce chest wall trauma and has been reported to reduce surgical mortality, preserve pulmonary function and improve patients’ postoperative quality of life 1, 4, 5.…”

Section: Introductionmentioning

confidence: 99%

Technical details of video‐assisted transcervical mediastinal dissection for esophageal cancer and its perioperative outcome

Mori

Aikou

Yagi

et al. 2017

Annals of Gastroent Surgery

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To reduce pulmonary complications after esophagectomy, the transthoracic procedure should be shortened or totally avoided. Transcervical approach assisted by mediastinoscope for the upper mediastinum may be advantageous for this purpose. We carried out video‐assisted transcervical mediastinal dissection (VATCMD) as part of totally non‐transthoracic radical esophagectomy. A single‐port laparoscopy device was adopted to a small cervical incision and the mediastinum was inflated with a positive pressure of 6 to 10 mmHg. Without assistant's retractor, the upper mediastinum and partially the middle mediastinum were dissected mainly by mediastinoscopic‐assisted surgery. Video of the operation is demonstrated with illustrations. We have carried out and reported 17 cases of esophagectomy including VATCMD and its perioperative outcome. Non‐transthoracic esophagectomy was completed without conversion to transthoracic procedure in all 17 cases. Procedure‐related adverse event was not observed and postoperative course was favorable with a zero occurrence (0%) of recurrent laryngeal nerve palsy, chyle leakage or pulmonary complications. Median number of harvested lymph nodes from the upper mediastinal stations was 10. VATCMD is suggested as a safe and feasible approach for the upper mediastinum in esophagectomy for malignancies. It enabled a totally non‐transthoracic radical esophagectomy in combination with a transhiatal approach.Video‐assisted transcervical mediastinal dissection is suggested as a safe and feasible approach for the upper mediastinum in esophagectomy for malignancies. It enabled a totally non‐transthoracic radical esophagectomy in combination with a transhiatal approach.

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Primary tracheobronchial necrosis after esophagectomy: A nationwide multicenter retrospective study in Japan

Sakai

Saeki

Sohda

et al. 2022

Annals of Gastroent Surgery

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Background The clinical features of postoperative primary tracheobronchial necrosis (P‐TBN; the necrosis without anastomotic leakage or other cervical and mediastinal abscess) remains unclear. This nationwide multicenter retrospective study first investigated the clinical features of P‐TBN after esophagectomy for upper aerodigestive tract cancer with a large cohort. Methods As a study of the Japan Broncho‐Esophagological Society, a nationwide questionnaire survey was conducted in 67 institutions. The clinical data of 6370 patients who underwent esophagectomy for laryngeal, pharyngeal, and esophageal cancer between 2010 and 2019 were collected. Grades of P‐TBN were defined as follows: Grade 1, mucosal necrosis; Grade 2, transmural bronchial wall necrosis without fistula or perforation; Grade 3, transmural bronchial wall necrosis with fistula or perforation. Results P‐TBN was observed in 48 (0.75%) of 6370 patients. The incidences of P‐TBN for pharyngo‐laryngo‐cervical esophagectomy (PLCE; n = 1650), total pharyngo‐laryngo‐esophagectomy (TPLE; n = 205), and subtotal esophagectomy (SE; n = 4515) were 2.0%, 5.4%, and 0.1%, respectively. The upper mediastinal LN dissection ( P = 0.016) and the higher level of the tracheal resection ( P = 0.039) were significantly associated with a higher grade of necrosis in PLCE and TPLE. Overall survival rates were significantly lower in patients with Grade 2 ( P = 0.009) and Grade 3 ( P = 0.004) than in those with Grade 1. Conclusion The incidence of TBN restricted to P‐TBN was lower than previously reported. Maintaining the tracheal blood flow is essential to prevent worsening P‐TBN, especially in PLCE and TPLE. Our new P‐TBN severity grade may predict the outcome of patients with P‐TBN.

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Video-assisted thoracoscopic esophagectomy and radical lymph node dissection for esophageal cancer

Abstract: Thoracoscopic radical esophagectomy has less morbidity and comparable survival to conventional surgery, after a moderate amount of experience. Mini-thoracotomy is essential to perform the procedure safely and effectively.

Cited by 66 publications

References 17 publications

Results of video-assisted thoracoscopic surgery for esophageal cancer during the induction period

Results of video-assisted thoracoscopic surgery for esophageal cancer during the induction period

Technical details of video‐assisted transcervical mediastinal dissection for esophageal cancer and its perioperative outcome

Primary tracheobronchial necrosis after esophagectomy: A nationwide multicenter retrospective study in Japan

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