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International Cancer Conference Journal

, Volume 7, Issue 2, pp 37–39 | Cite as

Laparoscopic transhiatal lymphadenectomy in the lower mediastinum for adenocarcinoma of the esophagogastric junction

  • Yousuke Kinjo
  • Seiji SatohEmail author
  • Shingo Ochi
  • Hiroyuki Matsubara
  • Atsushi Fukugaki
  • Kazuhiro Ohara
  • Masayoshi Iwamoto
  • Takuya Matsumoto
  • Takakazu Matsushita
  • Yasuo Wada
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Abstract

Laparoscopic transhiatal esophagogastrectomy is difficult because the lower mediastinum is so deeply located that the operative field is narrow and restricted by surrounding organs. Therefore, we performed lymphadenectomy with opening of the bilateral mediastinal pleura to maintain safety and obtain better exposure of lymph nodes and important organs. We will present our technique for laparoscopic lower mediastinal lymphadenectomy and reconstruction for cancer of the esophagogastric junction. Five abdominal ports were used. Retraction of the left lobe of the liver exposed the esophageal hiatus. A long, narrow gastric tube (3 cm wide) was formed, and regional abdominal lymph nodes (No. 1, 2, 3a, 7, 8a, 9, 19, and 20) were resected. The diaphragmatic hiatus was widely split and the opened bilateral mediastinal pleura enabled better exposure for lymph node dissection and reconstruction. The level where the inferior vena cava passed through the diaphragm into the chest was used as a landmark to identify supradiaphragmatic (No. 111) and lower thoracic paraesophageal nodes (No. 110), which were completely retrieved with this procedure. The posterior mediastinal nodes (No. 112pulR, 112pulL, and 112aoA) were also retrieved with bilateral opening of the mediastinal pleura and dissection of the inferior pulmonary ligaments. An esophagogastric tube anastomosis with pseudo-fornix was made with a no-knife linear stapler to prevent postoperative reflux esophagitis. This approach enabled safe and accurate laparoscopic lower mediastinal nodal dissection. With the advantage of a narrow gastric tube, the good working space made tension-free anastomosis possible.

Keywords

Esophagogastric cancer Laparoscopic surgery Adenocarcinoma Mediastinal lymphadenectomy 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that there are no conflicts of interest.

Supplementary material

Supplementary material 1 (MP4 92830 KB)

References

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Copyright information

© The Japan Society of Clinical Oncology 2018

Authors and Affiliations

  • Yousuke Kinjo
    • 1
  • Seiji Satoh
    • 1
    Email author
  • Shingo Ochi
    • 1
  • Hiroyuki Matsubara
    • 1
  • Atsushi Fukugaki
    • 1
  • Kazuhiro Ohara
    • 1
  • Masayoshi Iwamoto
    • 1
  • Takuya Matsumoto
    • 1
  • Takakazu Matsushita
    • 1
  • Yasuo Wada
    • 1
  1. 1.Department of SurgeryHimeji Medical CenterHimejiJapan

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