scholarly journals An Effective New Technique in the Elevation of Gastric Conduit Via the Posterior Mediastinal Route in Thoracoscopic Esophagectomy and Laparoscopic Gastric Conduit Reconstruction

2016 ◽  
Vol 41 (1) ◽  
pp. 8-14
Author(s):  
Nobutoshi Hagiwara ◽  
Takeshi Matsutani ◽  
Tsutomu Nomura ◽  
Itsuo Fujita ◽  
Yoshikazu Kanazawa ◽  
...  
Keyword(s):  
Gastric Conduit ◽  
Thoracoscopic Esophagectomy ◽  
New Technique ◽  
Posterior Mediastinal ◽  
Posterior Mediastinal Route

436 PRONE THORACOSCOPIC ESOPHAGECTOMY FOR PATIENTS WITH LOW PULMONARY FUNCTION

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Gosuke Takiguchi ◽  
Taro Oshikiri ◽  
Manabu Horikawa ◽  
Yu Kitamura ◽  
Kazumasa Horie ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Respiratory Function ◽  
Operation Time ◽  
Thoracoscopic Esophagectomy ◽  
Control Group ◽  
Respiratory Disorder ◽  
Short Term ◽  
Postoperative Respiratory Complications ◽  
Posterior Mediastinal ◽  
Posterior Mediastinal Route

Abstract   Thoracoscopic esophagectomy in the prone position (TEP) for esophageal cancer is reported to have superiority in preserving postoperative respiratory function and reducing postoperative respiratory complications. In Japan, the majority of patients with esophageal cancer are smokers and have obstructive ventilation disorders. But, the feasibirity and safety of TEP for patients with low respiratory function is unclear. Objectives To clarify the feasibirity and safety of TEP for esophageal cancer patients with obstructive respiratory function. Methods The 95 patients with obstructive respiratory disorder who underwent TEP and gastric tube reconstruction via posterior mediastinal route for esophageal cancer from January 2016 to April 2019 were divided into the two groups, low respiratory function (LRF) group and the control group. Short-term outcomes were compared between two groups. Results The control group was 73 cases, and the LRF group was 22 cases. Propensity score matching using age, gender, cT, and cN as covariates was used to identify matched patients (22 per group) in both groups. There were no differences in operation time of overall and intrathoracic part, or blood loss in each group. In the postoperative complications, pneumonia (13.6% vs. 9.1%), recurrent laryngeal palsy (18.2% vs. 22.7%), anastomotic leakage (13.6% vs. 13.6%) and hospital stay (36.3 days vs 27.5 days) were no differences in both groups. Conclusion TEP can be feasible and safe for the patients with obstructive ventilation disorder and low respiratory function.

scholarly journals Endoscopic submucosal dissection to relieve a flexure of the gastric conduit after esophagectomy

2018 ◽  
Vol 06 (03) ◽  
pp. E350-E353
Author(s):  
Katsumi Yamamoto ◽  
Hiroshi Noro ◽  
Yu Sato ◽  
Akira Kusakabe ◽  
Nobuyuki Tatsumi ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Balloon Dilation ◽  
Endoscopic Examination ◽  
Gastric Conduit ◽  
Endoscopic Balloon Dilation ◽  
Effective Treatment Option ◽  
Submucosal Dissection ◽  
First Case ◽  
Posterior Mediastinal ◽  
Endoscopic Balloon

Abstract Background and study aims A 70-year-old-man underwent an esophagectomy and posterior mediastinal reconstruction for esophageal cancer that was curatively resected. Although the patient was allowed to eat after surgery, he repeatedly vomited after drinking water or eating meals and required continuous hospitalization. An upper gastrointestinal series and endoscopic examination revealed an obstruction due to the flexure of the gastric conduit, which was repeatedly treated with endoscopic balloon dilation. Endoscopic balloon dilation was completely ineffective, however, because the obstruction was not due to a small lumen diameter, but rather to severe flexure. We hypothesized that the power of contraction provided by ulcer scar formation after mucosal resection could straighten the flexure, and thus removed a piece of the mucosa 8 cm in diameter on the oral side of the flexure by endoscopic submucosal dissection (ESD) 4 months after the esophagectomy. Endoscopic examination on post-ESD Day 10 revealed that the gastric conduit flexure was straightened due to ulcer scarring, and obstruction at the flexure opened over time. Meals were restarted and the patient could eat without vomiting. He was discharged from the hospital 5 weeks after ESD. This is the first case report of obstruction due to flexure of the gastric conduit after esophagectomy that was successfully treated with mucosectomy using ESD. Mucosectomy using ESD may be an effective treatment option for obstruction due to flexure of the gastric conduit after esophagectomy.

scholarly journals Comparison of the incidences of anastomotic leakage when PDSII or LACLON are used in esophago-gastric conduit handsewn anastomosis after esophagectomy

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yusuke Sato ◽  
Satoru Motoyama ◽  
Akiyuki Wakita ◽  
Yuta Kawakita ◽  
Yushi Nagaki ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Anastomotic Leakage ◽  
Odds Ratio ◽  
Gastric Conduit ◽  
University Hospital ◽  
Logistic Analysis ◽  
Handsewn Anastomosis ◽  
Surgical Sutures ◽  
Posterior Mediastinal

Abstract The incidence of anastomotic leakage after esophagectomy remains around 10%. It was previously reported that PDSII rapidly loses tensile strength at pH 1.0 and pH 8.5. By contrast, LACLON degradation is reportedly insensitive to pH. We therefore compared LACLON with PDSII for esophago-gastric conduit, layer-to-layer, handsewn anastomosis. Between January 2016 and January 2020, 90 patients who received posterior mediastinal gastric conduit reconstruction with layer-to-layer handsewn anastomosis (51 using PDSII and 39 using LACLON) at Akita University Hospital were enrolled. The incidence of anastomotic leakage was significantly lower in the LACLON (2.6%, 1/39 patients) than PDSII group (15.7%, 8/51 patients) (p = 0.0268). Multivariable logistic analysis showed the risk of anastomotic leakage was significantly greater with PDSII than LACLON (odds ratio 11.01; 95% CI 1.326–277.64; p = 0.024). The percentages of time the pH was higher than 8 on the gastric conduit side of the anastomosis were 3.1%, 5.7%, 20.9% and 80.5%, respectively, in the four most recent patients. The present study showed that pH at the anastomosis soon after esophagectomy tends to be alkaline rather than acidic, which raises the possibility that this alkalinity facilitates the deterioration of surgical sutures including PDSII.

scholarly journals Reconstruction after esophagectomy for esophageal cancer: Retrosternal or posterior mediastinal route?

2011 ◽  
Vol 74 (11) ◽  
pp. 505-510 ◽  
Author(s):  
Mei-Lin Chan ◽  
Chih-Cheng Hsieh ◽  
Cheng-Wien Wang ◽  
Min-Hsiung Huang ◽  
Wen-Hu Hsu ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Posterior Mediastinal ◽  
Posterior Mediastinal Route

Esophageal cancer treatment in our institute from 1999 to 2005

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15183-15183
Author(s):  
Y. Miyazaki ◽  
H. Imamura ◽  
T. Kishimoto ◽  
K. Yamamoto ◽  
H. Furukawa
Keyword(s):  
Esophageal Cancer ◽  
Surgical Treatment ◽  
Survival Rate ◽  
Cell Carcinoma ◽  
Neoadjuvant Chemoradiotherapy ◽  
The United States ◽  
Recurrent Nerve ◽  
Recurrent Nerve Palsy ◽  
Posterior Mediastinal ◽  
Posterior Mediastinal Route

15183 Background: 5 year survival rate of esophageal cancer in Japan reported to the Japanese Society for Esophageal Diseases from 1988 to 1994 (9,143 cases) was improved to 35.5% comparing to the rate of the beginning of 1980 which remained around 20%. This result was given by the increase of early cancer cases attributed to the progress of the ability of diagnosis, the improvement of the postoperative management, and the 3 field lymph node dissection introduced from the middle of 1980. Biological malignant potential and the modality of treatment for esophageal cancer in Japan differs from those in the United States. Methods: We studied clinicopathological characteristic and treatment results of 63 esophageal cancer patients in our institute from 1999 to 2005. Results: 63 patients consisted of 47 males and 16 females with mean age of 63.4±11.4. Out of 47 patients who underwent surgical treatment, 6 and 4 patients underwent neoadjuvant chemoradiotherapy and chemotherapy, respectively. 15 patients without surgical treatment consisted of 12 patients, including one patient after endoscopical mucosal resection, undergoing chemoradiotherapy, 2 patients undergoing chemotherapy, and 3 patients undergoing radiotherapy, respectively. Most common histological type was squamous cell carcinoma (55 patients), followed by adenocarcinoma (3 patients), small cell carcinoma(3 patients), others(2 patients), and unknown(1 patients). There was 1 surgical treatment-related death. The major complications were SSI (18 patients), anastomotic leakage(7 patients) and recurrent nerve palsy (5 patients). The 2-year survival rate of patients with surgical resection was 68.1%, while the rate of the unresectable patients was 38.9%.Since 2002, we have adopted posterior mediastinal route as a prime choice, rather than retrosternal route. The median amount of blood loss, rate of complications and duration of post operative hospital stay of each routes are 650/415(ml), 65/45(%), 35/22(day), respectively. These results suggested that posterior mediastinal route showed superiority comparing to restrosternal route. Conclusions: Backed by these outcomes, we will aim to establish a logical strategy for esophageal cancer therapy which could accompany fewer complications, respect quality of life and prolong survival time. No significant financial relationships to disclose.

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