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Left-primary & right-auxiliary operation mode in mediastinoscope-assisted radical esophagectomy

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Abstract

Background

Mediastinoscope-assisted transhiatal esophagectomy (MATHE) is the most minimally invasive esophagectomy procedure. It is a more challenging procedure and more difficult to be popularized than thoracoscopic surgery. We developed a new MATHE operation mode that provides a clearer visual field and makes the procedures simpler.

Methods

A total of 80 patients with esophageal cancer were divided into a control group (n = 29) and a study group (n = 51). The control group underwent classic MATHE, while the study group received modified MATHE. We compared the two groups on operation time; intraoperative blood loss; blood transfusion amount; incidence rate of lung infection, recurrent laryngeal nerves (RLNs) injury, chylothorax, and anastomotic leakage; and upper mediastinal lymph node dissection.

Results

The study group was significantly better than the control group in operation time (271.78 min vs. 322.90 min, p < 0.05), intraoperative blood loss (48.63 mL vs. 68.97 mL, p < 0.05), and left paratracheal lymph node (No. 4L) dissection rate (88.24% vs. 24.14%, p < 0.01). No significant differences were identified in the incidence rate of anastomotic leakage, lung complications, or RLNs injury between the two groups.

Conclusion

The modified MATHE is easier to perform. Modified MATHE is significantly superior to classic MATHE in operation time, intraoperative blood loss, and upper mediastinal lymph node dissection rate.

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References

  1. Nguyen NT, Follette DM, Wolfe BM, Schneider PD, Roberts P, Goodnight JE Jr (2000) Comparison of minimally invasive esophagectomy with transthoracic and transhiatal esophagectomy. Arch Surg 135:920–925. https://doi.org/10.1001/archsurg.135.8.920

    Article  CAS  PubMed  Google Scholar 

  2. Biere SS, van Berge Henegouwen MI, Maas KW, Bonavina L, Rosman C, Garcia JR, Gisbertz SS, Klinkenbijl JH, Hollmann MW, de Lange ES, Bonjer HJ, van der Peet DL, Cuesta MA (2012) Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 379(9829):1887–1892. https://doi.org/10.1016/S0140-6736(12)60516-9

    Article  PubMed  Google Scholar 

  3. Straatman J, van der Wielen N, Cuesta MA, Daams F, Roig Garcia J, Bonavina L, Rosman C, van Berge Henegouwen MI, Gisbertz SS, van der Peet DL (2017) Minimally invasive versus open esophageal resection: three-year follow-up of the previously reported randomized controlled trial: the TIME trial. Ann Surg 266(2):232–236. https://doi.org/10.1097/SLA.0000000000002171

    Article  PubMed  Google Scholar 

  4. Ikeda Y, Niimi M, Kan S, Sasaki Y, Shatari T, Takami H, Kodaira S (2001) Mediastinoscopic esophagectomy using carbon dioxide insufflation via the neck approach. Surgery 129:504–506. https://doi.org/10.1067/msy.2001.113040

    Article  CAS  PubMed  Google Scholar 

  5. Fujiwara H, Shiozaki A, Konishi H, Kosuga T, Komatsu S, Ichikawa D, Okamoto K, Otsuji E (2015) Single-port mediastinoscopic lymphadenectomy along the left recurrent laryngeal nerve. Ann Thorac Surg 100:1115–1117. https://doi.org/10.1016/j.athoracsur.2015.03.122

    Article  PubMed  Google Scholar 

  6. Fujiwara H, Shiozaki A, Konishi H, Otsuji E (2016) Mediastinoscope and laparoscope-assisted esophagectomy. J Vis Surg 2:125. https://doi.org/10.21037/jovs.2016.07.08

    Article  PubMed  PubMed Central  Google Scholar 

  7. Feng MX, Wang H, Zhang Y, Tan LJ, Xu ZL, Qun W (2012) Minimally invasive esophagectomy for esophageal squamous cell carcinoma: a case-control study of thoracoscope versus mediastinoscope assistance. Surg Endosc 26:1573–1578. https://doi.org/10.1007/s00464-011-2073-7

    Article  PubMed  Google Scholar 

  8. Egberts JH, Schlemminger M, Hauser C, Beckmann JH, Becker T (2019) Robot-assisted cervical esophagectomy (RACE procedure) using a single port combined with a transhiatal approach in a rendezvous technique: a case series. Langenbecks Arch Surg 404:353–358. https://doi.org/10.1007/s00423-019-01785-y

    Article  PubMed  Google Scholar 

  9. Okumura H, Uchikado Y, Matsumoto M, Omoto I, Sasaki K, Kita Y, Arigami T, Uenosono Y, Nakajo A, Owaki T, Mori S, Ishigami S, Natsugoe S (2015) Clinical significance of mediastinoscope-assisted transhiatal esophagectomy in patients with esophageal cancer. Langenbecks Arch Surg 400:699–706. https://doi.org/10.1007/s00423-015-1330-y

    Article  PubMed  Google Scholar 

  10. Tangoku A, Yoshino S, Abe T, Hayashi H, Satou T, Ueno T, Oka M (2004) Mediastinoscope-assisted transhiatal esophagectomy for esophageal cancer. Surg Endosc 18:383–389. https://doi.org/10.1007/s00464-003-8181-2

    Article  CAS  PubMed  Google Scholar 

  11. Mori K, Aikou S, Yagi K, Nishida M, Mitsui T, Yamagata Y, Yamashita H, Nomura S, Seto Y (2017) Technical details of video-assisted transcervical mediastinal dissection for esophageal cancer and its perioperative outcome. Ann Gastroenterol Surg 1:232–237. https://doi.org/10.1002/ags3.12022

    Article  PubMed  PubMed Central  Google Scholar 

  12. Guo L, Zhao Q, Wang K, Zhao D, Ye X, Li T (2021) A case-control study on the therapeutic effect of mediastinoscope-assisted and thoracoscope-assisted esophagectomy. Surg Innov 28:316–322. https://doi.org/10.1177/1553350620958265

    Article  PubMed  Google Scholar 

  13. Xu L, Wei XF, Chen XK, Qi S, Yu YK, Liu Q, Xie HN, Yang YF, Zhang RX, Li Y (2022) Clinical significance of left tracheobronchial lymph node dissection in thoracic esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg 164(4):1210-1219.e3. https://doi.org/10.1016/j.jtcvs.2022.02.050

    Article  PubMed  Google Scholar 

  14. Lin J, Kang M, Chen S, Deng F, Han Z, Lin J (2016) Feasibility and strategy for left tracheobronchial lymph node dissection in thoracolaparoscopic esophageal cancer surgery. Thorac Cancer 7(2):199–206. https://doi.org/10.1111/1759-7714.12312

    Article  PubMed  Google Scholar 

  15. Daiko H, Oguma J, Fujiwara H, Ishiyama K, Kurita D, Sato T, Sato K, Faiz Z, Fujita T (2021) Novel universally applicable technique for performing bilateral transcervical mediastinoscopic-assisted transhiatal laparoscopic esophagectomy: a truly minimally invasive procedure. Surg Endosc 35:5186–5192. https://doi.org/10.1007/s00464-020-08012-6

    Article  PubMed  Google Scholar 

  16. Boshier PR, Anderson O, Hanna GB (2011) Transthoracic versus transhiatal esophagectomy for the treatment of esophagogastric cancer: a meta-analysis. Ann Surg 254:894–906. https://doi.org/10.1097/SLA.0b013e3182263781

    Article  PubMed  Google Scholar 

  17. Fujiwara H, Shiozaki A, Konishi H, Kosuga T, Komatsu S, Ichikawa D, Okamoto K, Otsuji E (2017) Perioperative outcomes of single-port mediastinoscope-assisted transhiatal esophagectomy for thoracic esophageal cancer. Dis Esophagus 30:1–8. https://doi.org/10.1093/dote/dox047

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

This study was funded by 1•3•5 project for disciplines of excellence–Clinical Research Incubation Project, West China Hospital, Sichuan University (2018HXFH039), and did not receive any commercial interest support.

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Authors and Affiliations

  1. Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China

    Peisong Yuan, Weipeng Hu, Zheng Liu, Na Wu, Haonan Lin & Yang Hu

  2. Department of Surgical Division I, Traditional Chinese Medicine Hospital of Wusheng County, Guangan, 638400, China

    Shiyu Li

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  1. Peisong Yuan
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  2. Weipeng Hu
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  3. Zheng Liu
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  4. Na Wu
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  7. Yang Hu
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Correspondence to Yang Hu.

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Peisong Yuan, Weipeng Hu, Zheng Liu, Na Wu, Haonan Lin, Shiyu Li and Yang Hu have no conflicts of interest or financial ties to disclose.

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Yuan, P., Hu, W., Liu, Z. et al. Left-primary & right-auxiliary operation mode in mediastinoscope-assisted radical esophagectomy. Surg Endosc 37, 7884–7892 (2023). https://doi.org/10.1007/s00464-023-10341-1

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  • DOI: https://doi.org/10.1007/s00464-023-10341-1

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