EAES Online Library. Kiguchi G. Jan 10, 2012; 19955
Dr. Gozo Kiguchi
Dr. Gozo Kiguchi
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BACKGROUND: Adenocarcinoma of esophagogastric junction shows worldwide an increasing incidence. The optimal approach to resection is still controversial. One of the major disadvantages of radical esophagectomy with open technique is its high rate of morbidity and mortality. Recent advances in minimally invasive surgical technology have allowed surgeons to apply laparoscopy with only abdominal approach to perform resection of the advanced esophagogastric cancer.
PATIENT AND METHODS: In the video we report the case of a 73 years old man with Siewert Ⅱ advanced adenocarcinoma of esophagogastric junction, who was submitted to a minimally invasive proximal gastrectomy with transhiatal resection of the distal esophagus by laparoscopy. The patient was admitted to our hospital with complaints of epigastric pain. Preoperative endoscopy showed an advanced esophagogastric cancer that had invaded the lower esophagus within 2 cm from esophagogastric junction. A biopsy specimen revealed a moderately differentiated adenocarcinoma. Abdominal computed tomography (CT) showed a marked thickening of the wall of the proximal stomach wall. Enlarged lymph nodes were present only around the lesser curvature. The patient was then taken to the operating room. Five ports were used for the abdominal approach. A complete mobilization of the stomach preserving the right gastroepiploic arcade was achieved. The distal esophagus was resected with the autosuture device after splitting of the esophageal hiatus widely and getting a good access to the lower esophagus and lower posterior mediastinum. Lymph nodes of paracardial region, lesser curvatures, left gastric artery towards celiac axis, splenic artery, superior border of the pancreas towards the splenic hilum, and lower posterior mediastinum were also removed. After extraction of the specimen through a small abdominal incision, the stomach was pulled up to the distal esophageal stump, and esophagogastric anastomosis with the double stapling technique was constructed with transhiatal approach. The patient was discharged uneventfully on postoperative day 20. Eleven metastatic lymph nodes / thirty five regional lymph nodes were found. Pathology showed pT3 pN2 adenocarcinoma with R0 resection.
CONCLUSIONS: The minimally invasive transhiatal approach to adenocarcinoma of esophagogastric junction is feasible and safe.
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