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Posterior mediastinal lymph node dissection using the pneumomediastinum method for esophageal cancer

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Abstract

Although posterior mediastinal lymph node metastases are often observed in patients with esophageal cancer, their complete resection via a right thoracic approach is difficult and carries a risk of complications. We have developed a novel procedure for en-bloc dissection of the posterior mediastinal lymph nodes using the pneumomediastinum method. The patient was a 48-year-old female with middle thoracic esophageal cancer. A computed tomography scan showed a posterior mediastinal lymph node 1 cm in diameter. After division of the gastrosplenic ligament by hand-assisted laparoscopic surgery, the esophageal hiatus was opened, and carbon dioxide was introduced into the mediastinum. The anterior and left sides of the distal esophagus were separated, and a swollen posterior mediastinal lymph node was detected. Subsequently, the adventitia of the thoracic aorta was exposed, and the posterior side of the lymph node was separated. While lifting these nodes like a membrane, we cut them along the border of the left mediastinal pleura. Histopathological examination revealed a single squamous cell carcinoma metastasis in the resected lymph node. A good surgical view was obtained in our surgical procedure, and en-bloc dissection of the posterior mediastinal lymph nodes was safely performed.

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References

  1. Tachibana M, Kinugasa S, Yoshimura H, Shibakita M, Tonomoto Y, Dhar DK, et al. Clinical outcomes of extended esophagectomy with three-field lymph node dissection for esophageal squamous cell carcinoma. Am J Surg. 2005;189:98–109.

    Article  PubMed  Google Scholar 

  2. Ozawa S, Tachimori Y, Baba H, Fujishiro M, Matsubara H, Numasaki H, et al. Comprehensive registry of esophageal cancer in Japan, 2003. Esophagus. 2011;8:9–29.

    Article  Google Scholar 

  3. Japan Esophageal Society. Japanese classification of esophageal cancer, tenth edition: part I. Esophagus. 2009;6:1–25.

    Google Scholar 

  4. Japan Esophageal Society. Japanese classification of esophageal cancer, tenth edition: part II and III. Esophagus. 2009;6:71–94.

    Google Scholar 

  5. Shiozaki A, Fujiwara H, Daisuke I, Okamoto K, Komatsu S, Otsuji E. Pneumomediastinum method for esophageal cancer. Operation. 2011;65:1277–80.

    Google Scholar 

  6. Whooley BP, Law S, Murthy SC, Alexandrou A, Wong J. Analysis of reduced death and complication rates after esophageal resection. Ann Surg. 2001;233:338–44.

    Article  PubMed  CAS  Google Scholar 

  7. Law S, Wong KH, Kwok KF, Chu KM, Wong J. Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg. 2004;240:791–800.

    Article  PubMed  Google Scholar 

  8. Ferguson MK, Durkin AE. Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer. J Thorac Cardiovasc Surg. 2002;123:661–9.

    Article  PubMed  Google Scholar 

  9. Bailey SH, Bull DA, Harpole DH, Rentz JJ, Neumayer LA, Pappas TN, et al. Outcomes after esophagectomy: a ten-year prospective cohort. Ann Thorac Surg. 2003;75:217–22.

    Article  PubMed  Google Scholar 

  10. Zingg U, Forberger J, Frey DM, Esterman AJ, Oertli D, Beck-Schimmer B, et al. Inflammatory response in ventilated left and collapsed right lungs, serum and pleural fluid, in transthoracic esophagectomy for cancer. Eur Cytokine Netw. 2010;21:50–7.

    PubMed  CAS  Google Scholar 

  11. De Conno E, Steurer MP, Wittlinger M, Zalunardo MP, Weder W, Schneiter D, et al. Anesthetic-induced improvement of the inflammatory response to one-lung ventilation. Anesthesiology. 2009;110:1316–26.

    Article  PubMed  Google Scholar 

  12. Osugi H, Takemura M, Lee S, Nishikawa T, Fukuhara K, Iwasaki H, et al. Thoracoscopic esophagectomy for intrathoracic esophageal cancer. Ann Thorac Cardiovasc Surg. 2005;11:221–7.

    PubMed  Google Scholar 

  13. Osugi H, Takemura M, Higashino M, Takada N, Lee S, Kinoshita H. A comparison of video-assisted thoracoscopic oesophagectomy and radical lymph node dissection for squamous cell cancer of the oesophagus with open operation. Br J Surg. 2003;90:108–13.

    Article  PubMed  CAS  Google Scholar 

  14. Thomson IG, Smithers BM, Gotley DC, Martin I, Thomas JM, O’Rourke P, et al. Thoracoscopic-assisted esophagectomy for esophageal cancer: analysis of patterns and prognostic factors for recurrence. Ann Surg. 2010;252:281–91.

    Article  PubMed  Google Scholar 

  15. Noshiro H, Iwasaki H, Kobayashi K, Uchiyama A, Miyasaka Y, Masatsugu T, et al. Lymphadenectomy along the left recurrent laryngeal nerve by a minimally invasive esophagectomy in the prone position for thoracic esophageal cancer. Surg Endosc. 2010;24:2965–73.

    Article  PubMed  Google Scholar 

  16. Cadière GB, Dapri G, Himpens J, Rajan A. Thoracoscopic esophagectomy in prone position. Ann Surg Oncol. 2011;18:838.

    Article  PubMed  Google Scholar 

  17. Tangoku A, Yoshino S, Abe T, Hayashi H, Satou T, Ueno T, et al. Mediastinoscope-assisted transhiatal esophagectomy for esophageal cancer. Surg Endosc. 2004;18:383–9.

    Article  PubMed  CAS  Google Scholar 

  18. Mimatsu K, Oida T, Kawasaki A, Aramaki O, Kuboi Y, Kanou H, et al. Mediastinoscopy-assisted esophagectomy is useful technique for poor surgical-risk patients with thoracic esophageal cancer. Surg Laparosc Endosc Percutan Tech. 2009;19:e17–20.

    Article  PubMed  Google Scholar 

  19. Parker M, Pfluke JM, Shaddix KK, Asbun HJ, Smith CD, Bowers SP. Transcervical videoscopic esophageal dissection in minimally invasive esophagectomy. Surg Endosc. 2011;25:941–2.

    Article  PubMed  Google Scholar 

  20. Ikeda Y, Niimi M, Kan S, Takami H, Kodaira S. Thoracoscopic esophagectomy combined with mediastinoscopy via the neck. Ann Thorac Surg. 2002;73:1329–31.

    Article  PubMed  Google Scholar 

  21. Martin DJ, Bessell JR, Chew A, Watson DI. Thoracoscopic and laparoscopic esophagectomy: initial experience and outcomes. Surg Endosc. 2005;19:1597–601.

    Article  PubMed  CAS  Google Scholar 

  22. Bernabe KQ, Bolton JS, Richardson WS. Laparoscopic hand-assisted versus open transhiatal esophagectomy: a case-control study. Surg Endosc. 2005;19:334–7.

    Article  PubMed  CAS  Google Scholar 

  23. Glasgow RE, Swanstrom LL. Hand-assisted gastroesophageal surgery. Semin Laparosc Surg. 2001;8:135–44.

    Article  PubMed  CAS  Google Scholar 

  24. DePaula AL, Hashiba K, Ferreira EA, de Paula RA, Grecco E. Laparoscopic transhiatal esophagectomy with esophagogastroplasty. Surg Laparosc Endosc. 1995;5:1–5.

    PubMed  CAS  Google Scholar 

  25. Bonavina L, Bona D, Binyom PR, Peracchia A. A laparoscopy-assisted surgical approach to esophageal carcinoma. J Surg Res. 2004;117:52–7.

    Article  PubMed  Google Scholar 

  26. Montenovo MI, Chambers K, Pellegrini CA, Oelschlager BK. Outcomes of laparoscopic-assisted transhiatal esophagectomy for adenocarcinoma of the esophagus and esophago-gastric junction. Dis Esophagus. 2011;24:430–6.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan

    Atsushi Shiozaki, Hitoshi Fujiwara, Yasutoshi Murayama, Shuhei Komatsu, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Kazuma Okamoto, Toshiya Ochiai, Yukihito Kokuba & Eigo Otsuji

Authors
  1. Atsushi Shiozaki
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  2. Hitoshi Fujiwara
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  3. Yasutoshi Murayama
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  4. Shuhei Komatsu
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  5. Yoshiaki Kuriu
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  6. Hisashi Ikoma
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  7. Masayoshi Nakanishi
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  8. Daisuke Ichikawa
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  9. Kazuma Okamoto
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  10. Toshiya Ochiai
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  11. Yukihito Kokuba
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  12. Eigo Otsuji
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Correspondence to Atsushi Shiozaki.

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Shiozaki, A., Fujiwara, H., Murayama, Y. et al. Posterior mediastinal lymph node dissection using the pneumomediastinum method for esophageal cancer. Esophagus 9, 58–64 (2012). https://doi.org/10.1007/s10388-011-0304-6

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  • DOI: https://doi.org/10.1007/s10388-011-0304-6

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