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Esophagus

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A feasibility study of mediastinoscopic radical esophagectomy for thoracic esophageal cancer from the viewpoint of the dissected mediastinal lymph nodes validated with thoracoscopic procedure: a prospective clinical trial

  • Yutaka TokairinEmail author
  • Yasuaki Nakajima
  • Kenro Kawada
  • Akihiro Hoshino
  • Takuya Okada
  • Tairo Ryotokuji
  • Taichi Ogo
  • Masafumi Okuda
  • Yuichiro Kume
  • Yudai Kawamura
  • Kazuya Yamaguchi
  • Kagami Nagai
  • Tatsuyuki Kawano
  • Yusuke Kinugasa
Original Article
  • 5 Downloads

Abstract

Purpose

A prospective trial evaluated the feasibility and safety of “mediastinoscopic esophagectomy with lymph node dissection” (MELD).

Methods

Eligible patients had thoracic esophageal squamous cell carcinoma, excluding T4, a bulky primary lesion or distant metastasis. Ten patients were enrolled and treated between September 2015 and March 2018. Additionally, to verify the integrity of the mediastinal lymph node dissection, thoracoscopic observation and lymph node dissection were followed. The primary end point was the integrity of mediastinal lymph node dissection. The secondary end points were the short-term outcomes, including mortality and morbidity.

Results

The median number of dissected lymph nodes in the upper mediastinal to cervical region and middle to lower mediastinal region by mediastinoscopy/thoracoscopy was 27/0.5 and 11.5/0, respectively. The median total operation time was 615 min, the median bleeding amount was 476 ml, and the median postoperative hospital stay was 15.5 days. Regarding complications of more than grade III according to the Clavien–Dindo classification, four had sputum excretion difficulty, one had pneumothorax and one had bilateral recurrent nerve palsy, but none required conversion to thoracotomy, and no operative deaths occurred.

Conclusion

Although the rate of recurrent nerve palsy still should be reduced, our mediastinoscopic lymphadenectomy technique is closely similar to radical esophagectomy.

Keywords

Mediastinoscopy Pneumomediastinum Esophagectomy Esophageal cancer Minimally invasive esophagectomy 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflicts of interest.

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Copyright information

© The Japan Esophageal Society and Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Yutaka Tokairin
    • 1
    Email author
  • Yasuaki Nakajima
    • 1
  • Kenro Kawada
    • 1
  • Akihiro Hoshino
    • 1
  • Takuya Okada
    • 1
  • Tairo Ryotokuji
    • 1
  • Taichi Ogo
    • 1
  • Masafumi Okuda
    • 1
  • Yuichiro Kume
    • 1
  • Yudai Kawamura
    • 1
  • Kazuya Yamaguchi
    • 1
  • Kagami Nagai
    • 1
  • Tatsuyuki Kawano
    • 2
  • Yusuke Kinugasa
    • 1
  1. 1.Department of Gastrointestinal SurgeryTokyo Medical and Dental UniversityTokyoJapan
  2. 2.Department of SurgerySoka Municipal HospitalSaitamaJapan

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