Skip to main content

Advertisement

Log in

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

  • Video Article
  • Published:
International Cancer Conference Journal Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Siewert RJ, Feith M, Werner M et al (2000) Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1002 consecutive patients. Ann Surg 232:353–361

    Article  Google Scholar 

  2. Hosoda K, Yamashita K, Katada N et al (2015) Impact of lower mediastinal lymphadenectomy for the treatment of esophagogastric junction carcinoma. Anticancer Res 35:445–456

    PubMed  Google Scholar 

  3. Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14: 101–112

    Article  Google Scholar 

  4. Kinoshita T, Kaito A (2017) Current status and future perspectives of laparoscopic radical surgery for advanced gastric cancer. Transl Gastroenterol Hepatol 2:43

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hosogi H, Yoshimura F, Yamamura T et al (2014) Esophagogastric tube reconstruction with stapled pseudo-fornix in laparoscopic proximal gastrectomy: a novel technique proposed for Siwert type II tumors. Langenbecks Arch Surg 399:517–523

    Article  PubMed  Google Scholar 

  6. Inaba K, Satoh S, Ishida Y et al (2010) Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. J Am Coll Surg 211:e25–e22

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Seiji Satoh.

Ethics declarations

Conflict of interest

The authors declare that there are no conflicts of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (MP4 92830 KB)

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kinjo, Y., Satoh, S., Ochi, S. et al. Laparoscopic transhiatal lymphadenectomy in the lower mediastinum for adenocarcinoma of the esophagogastric junction. Int Canc Conf J 7, 37–39 (2018). https://doi.org/10.1007/s13691-018-0318-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13691-018-0318-1

Keywords

Navigation