Aoyama Shu, Tanaka Koji, Yamashita Kotaro, Makino Tomoki, Tsujii Yoshiki, Saito Takuro, Yamamoto Kazuyoshi, Takahashi Tsuyoshi, Kurokawa Yukinori, Nakajima Kiyokazu, Takehara Tetsuo, Eguchi Hidetoshi, Doki Yuichiro
Dept. of Gastroenterological Surgery, Graduate School of Medicine, Osaka University.
Gan To Kagaku Ryoho. 2022 Dec;49(13):1911-1913.
Surgical treatment of gastric tube cancer after thoracic gastrectomy is highly invasive, especially for gastric tube cancer of the posterior mediastinal tract, and in some cases, a reduction surgery is an option. We have experienced 4 cases of posterior mediastinal reconstructive gastric tube cancer in which local resection by thoracoscopic and endoscopic cooperative surgery( TECS)was conducted. All cases had undergone video-assisted thoracoscopic subtotal esophagectomy and posterior mediastinal gastric tube reconstruction for thoracic esophageal cancer. In 1 case, endoscopic submucosal dissection was performed, but it showed positive for vertical margins. Other cases were not indicated for endoscopic resection. Considering the patient's background, we decided to preserve the gastric tube and planned local resection by TECS. One patient was transferred to open thoracotomy due to severe adhesion, and 1 patient underwent segmental resection and 2-stage reconstruction due to narrowing of the gastric tube lumen at the suture closure. In all cases, the resection margins were negative and the patients are alive without recurrence of gastric tube cancer. Local resection of gastric tube with TECS for posterior mediastinal tract reconstructive gastric tube cancer may be useful as a less invasive surgical treatment.
胸段胃切除术后胃管癌的手术治疗具有高度侵袭性，尤其是对于后纵隔段的胃管癌，在某些情况下，缩小手术是一种选择。我们有4例后纵隔重建性胃管癌病例，采用了胸腔镜与内镜联合手术（TECS）进行局部切除。所有病例均接受了电视辅助胸腔镜下食管次全切除术及后纵隔胃管重建术治疗胸段食管癌。其中1例进行了内镜黏膜下剥离术，但切缘垂直方向呈阳性。其他病例不适合内镜切除。考虑到患者的背景情况，我们决定保留胃管并计划通过TECS进行局部切除。1例患者因严重粘连而转为开胸手术，1例患者因胃管腔在缝合处狭窄而进行了节段性切除及二期重建。所有病例的切缘均为阴性，患者存活且未出现胃管癌复发。对于后纵隔段重建性胃管癌，采用TECS进行胃管局部切除作为一种微创外科治疗方法可能是有用的。
