Surgery for Esophageal Squamous Cell Carcinoma: Techniques and Complications
Speaker
 | Koichi SUDA Professor and Head Department of Surgery Fujita Health University, Japan |
Talk Abstract
Background: The outermost layer of the autonomic nerves is the thin loose connective tissue layer between the autonomic nerve sheaths of the major anatomical structures and the adipose tissue bearing lymphatic tissue. We have demonstrated that systematic lymph node dissection in patients with gastric cancer could be sufficiently and reproducibly achieved along the outermost layer. Since 2018, similar concept has been extensively used for robotic esophagectomy for esophageal cancer (RE).
Methods: da Vinci Xi Surgical System (Intuitive Surgical) was used. In the thoracic phase, 5 trocars were placed in the semi-prone position, the patient cart was docked targeting at the caudal edge of the azygos arch, and the right trans-thoracic esophagectomy was performed using the double bipolar method based on the concept of the outermost layer-oriented approach. The recurrent laryngeal nerves were detected, and their function was preserved using the nerve integrity monitoring. Retrosternal circular stapled end-to-side esophagogastrostomy was created. Since May 2019, so-called keyhole procedure has been added especially when a 21mm circular stapler is used. Sixty-six patients who underwent RE between 2018 and 2021 were retrospectively reviewed.
Results: Clinical Stages 0, I, II, III, and IVa were seen in 3(4.5), 23 (34.8%), 23 (34.8%), 16 (24.2%), and 1(1.5%) patients, respectively. The thoracic console time, thoracic blood loss, the number of dissected lymph nodes, duration of postoperative hospital stay, and morbidity (Grade ≥IIIa), were 243(220-274) min, 23(16-31) g, 47(38-56), and 24(18-39) days, and 10.6%, respectively. The incidence of RLNP (Grade ≥I), anastomotic leakage (Grade ≥IIIa), anastomotic stenosis (Grade ≥IIIa), and 90-day mortality were 16.7%, 3.0%, 1.5%, and 0%, individually. The 3-year overall survival and recurrence-free survival rates were 88.8% and 67.8%, respectively.
Conclusions: RE with the outermost layer-oriented approach can be safely performed from a surgical and oncological point of view.