Department of Surgery, Osaka Red Cross Hospital, 5-30 Fudegasakicho, Tennoji Ward, Osaka, Osaka, 543-8555, Japan.
Department of Surgery, Osaka Red Cross Hospital, 5-30 Fudegasakicho, Tennoji Ward, Osaka, Osaka, 543-8555, Japan.
Surg Oncol. 2021 Mar;36:34-35. doi: 10.1016/j.suronc.2020.11.010. Epub 2020 Nov 21.
According to previous studies, transhiatal lower mediastinal lymph node (LMLN) dissection is recommended for patients with adenocarcinoma of esophagogastric junction (AEG) with esophageal involvement of <3.0 cm [1-3]. Herein, we reported our procedure and the short-term outcomes.
The patient was placed in a supine position under general anesthesia, and five ports were placed into the upper abdomen. After radical suprapancreatic lymph node dissection, the center of the phrenic tendon was cut and each phrenic crus was retracted laterally to obtain good operative field. The ventral tissue along the lower esophagus was dissected from the pericardia. The dissection proceeded to the right atrium along the IVC. The dorsal tissue was dissected from the aorta. The remaining plate-like tissue was dissected from the pleura. Finally, the dissected tissue was peeled back from the esophagus.
Twenty-four patients with Siewert type II/III AEG underwent this procedure at our hospital between April 2011 and December 2019. Two cases were administered with the right thoracic approach to secure proximal margin or perform anastomosis safely. All cases underwent R0 resection. Although the Clavien-Dindo grade IIIa anastomotic leakage was confirmed in two cases (8.3%), there were no complications associated with the procedure. The median number of retrieved LMLN was five (range 0-14). Two patients had metastatic LMLN. The length of esophageal involvement in patients with metastatic LMLN was longer than that in patients with nonmetastatic LMLN (26 mm vs 12.5 mm).
Our procedure was safe and feasible for lymph node dissection in AEG.
根据既往研究，对于食管胃结合部腺癌（AEG）且食管受累<3.0cm的患者，推荐行经食管裂孔下纵隔淋巴结（LMLN）清扫[1-3]。本文报道了我们的手术步骤和短期结果。
患者全身麻醉后取仰卧位，在上腹部放置 5 个端口。在完成根治性胰上旁淋巴结清扫后，切开膈神经中心，将每侧膈神经脚向外侧牵拉，以获得良好的手术视野。沿下段食管的腹侧组织与心包分离。沿 IVC 向右侧心房解剖。背侧组织与主动脉分离。将剩余的板状组织从胸膜分离。最后，将剥离的组织从食管向后拉。
2011 年 4 月至 2019 年 12 月，我院 24 例 Siewert Ⅱ/Ⅲ型 AEG 患者接受了该手术。其中 2 例采用右胸入路以确保近端切缘或安全吻合。所有患者均行 R0 切除。虽然有 2 例（8.3%）发生了 Clavien-Dindo Ⅲa 级吻合口漏，但无手术相关并发症。LMLN 清扫数目中位数为 5（0-14）枚。2 例患者存在 LMLN 转移。LMLN 转移患者的食管受累长度长于非转移患者（26mm 比 12.5mm）。
我们的手术步骤对于 AEG 的淋巴结清扫是安全可行的。
