Fang Wentao, Ji Chunyu, Feng Jian, Zhao Weigang, Zhang Xuefei
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai 200030, China.
J Vis Surg. 2016 Sep 5;2:151. doi: 10.21037/jovs.2016.08.09. eCollection 2016.
Minimally invasive esophagectomy has been gaining increasing interest in management of early stage esophageal cancers. Similar oncological principles including radical removal of the tumor as well as systemic lymph node dissection should be observed, regardless of the surgical approach. Improvement in surgical techniques would help achieve comparable oncological outcomes while help patients benefit from the minimally invasive approach. This video introduces an antegrade dissection which is an alternative to the traditional retrograde esophagectomy for squamous cell carcinoma of the thoracic esophagus.
A 54-year-old male patient had a cT1bN0M0 (stage I) squamous cell carcinoma in the middle thoracic esophagus. The surgery selected was thoracoscopic-laparoscopic three-hole esophagectomy with thoraco-abdominal two-field lymph-adenectomy. In the chest part of the procedure, dissection was carried out in an antegrade fashion, from the apex of the chest downwards to the diaphragm. The thoracic esophagus and the tumor was resected en-bloc with surrounding connective tissue. Thorough lymph node dissection was carefully completed, with special attention paid to those along the bilateral recurrent laryngeal nerves.
The patient recovered uneventfully and was discharged on postoperative day 6. Pathologic study revealed a pT1bN1M0 (stage IIb) tumor, with lymphatic involvement detected in a right recurrent nerve node.
With the help of minimally invasive approach, rapid recovery from the extensive esophagectomy could be expected. However, it is critically important to make sure that the same oncological principles including a radical resection margin and a thorough lymph node dissection should also be observed. For the thoracic part of the procedure, an antegrade dissection could help achieve this goal, while making surgical maneuver simpler and safer.
微创食管切除术在早期食管癌的治疗中越来越受到关注。无论采用何种手术方式，都应遵循相似的肿瘤学原则，包括肿瘤的根治性切除以及系统性淋巴结清扫。手术技术的改进有助于在实现可比的肿瘤学结局的同时，让患者从微创方法中获益。本视频介绍一种顺行解剖法，它是治疗胸段食管鳞状细胞癌的传统逆行食管切除术的替代方法。
一名54岁男性患者患有胸段食管中段cT1bN0M0（I期）鳞状细胞癌。选择的手术方式是胸腔镜-腹腔镜三孔食管切除术加胸腹两野淋巴结清扫术。在手术的胸部部分，采用顺行方式进行解剖，从胸部顶端向下至膈肌。将胸段食管和肿瘤与周围结缔组织整块切除。仔细完成彻底的淋巴结清扫，特别注意双侧喉返神经旁的淋巴结。
患者恢复顺利，术后第6天出院。病理研究显示为pT1bN1M0（IIb期）肿瘤，在右侧喉返神经淋巴结中检测到淋巴转移。
借助微创方法，有望从广泛的食管切除术中快速恢复。然而，至关重要的是要确保同样遵循包括根治性切缘和彻底淋巴结清扫在内的肿瘤学原则。对于手术的胸部部分，顺行解剖法有助于实现这一目标，同时使手术操作更简单、更安全。
