Fujiwara H, Shiozaki A, Konishi H, Kosuga T, Komatsu S, Ichikawa D, Okamoto K, Otsuji E
Dis Esophagus. 2017 Oct 1;30(10):1-8. doi: 10.1093/dote/dox047.
We developed an en bloc lymphadenectomy method in the upper mediastinum with a single-port mediastinoscopic cervical approach. This study was designed to evaluate the safety and efficacy of single-port mediastinoscope-assisted transhiatal esophagectomy for thoracic esophageal cancer. The perioperative outcomes of 60 patients with thoracic esophageal cancer who underwent this operation between March 2014 and June 2016 were retrospectively analyzed. The upper mediastinal dissection including lymphadenectomy along the left recurrent laryngeal nerve, using a left cervical approach, was performed with a single-port mediastinoscopic technique, which was used to improve the visibility and handling in the deep mediastinum around the aortic arch. The lymphadenectomy along the right recurrent laryngeal nerve was performed under direct vision using a right cervical approach. Bilateral cervical approaches were followed by hand-assisted laparoscopic transhiatal esophagectomy with en bloc lymphadenectomy in the middle and lower mediastinum. Tumors were mainly located in the middle thoracic esophagus (n = 33), and most tumors were squamous cell carcinoma (n = 58). Pretreatment diagnoses were stage I, 19; II, 13; III, 24; IV, 4. Preoperative chemotherapy was performed for 40 patients. The median operation time and blood loss were 363 minutes and 235 mL, respectively. There were two patients who underwent conversion to thoracotomy. Perioperative complications were evaluated and graded according to the Clavien-Dindo (CD) and the Esophagectomy Complications Consensus Group (ECCG) classifications. Postoperatively, pneumonia was observed in four patients (CD, Grade II, 2; Grade IIIb, 2), although vocal cord palsy was more frequent (ECCG, Type I, 12; Type III, 8). The median number of thoracic lymph nodes resected was 21, and the R0 resection rate was 95%. Single-port mediastinoscope-assisted transhiatal esophagectomy is feasible, in terms of perioperative outcomes, for a radical surgery for thoracic esophageal cancer, although its safety needs to be further demonstrated.
我们采用单孔纵隔镜颈部入路开发了一种上纵隔整块淋巴结清扫方法。本研究旨在评估单孔纵隔镜辅助经裂孔食管癌切除术治疗胸段食管癌的安全性和有效性。回顾性分析了2014年3月至2016年6月期间接受该手术的60例胸段食管癌患者的围手术期结果。采用单孔纵隔镜技术经左颈部入路进行上纵隔清扫，包括沿左喉返神经进行淋巴结清扫，该技术用于改善主动脉弓周围深纵隔的视野和操作。沿右喉返神经的淋巴结清扫在直视下经右颈部入路进行。双侧颈部入路后，行手辅助腹腔镜经裂孔食管癌切除术并整块清扫中、下纵隔淋巴结。肿瘤主要位于胸段食管中段（n = 33），大多数肿瘤为鳞状细胞癌（n = 58）。术前诊断为Ⅰ期19例；Ⅱ期13例；Ⅲ期24例；Ⅳ期4例。40例患者接受了术前化疗。中位手术时间和失血量分别为363分钟和235毫升。有2例患者转为开胸手术。根据Clavien-Dindo（CD）和食管癌切除并发症共识组（ECCG）分类对围手术期并发症进行评估和分级。术后，4例患者出现肺炎（CD分级：Ⅱ级2例；Ⅲb级2例），尽管声带麻痹更为常见（ECCG分型：Ⅰ型12例；Ⅲ型8例）。胸段淋巴结清扫的中位数量为21枚，R0切除率为95%。单孔纵隔镜辅助经裂孔食管癌切除术在围手术期结果方面对于胸段食管癌的根治性手术是可行的，尽管其安全性仍需进一步证实。
