title: [Salvage esophagectomy via a laparoscopic transhiatal approach for the treatment of esophageal cancer].
abstract: We started performing esophagectomy via a laparoscopic transhiatal approach (LTHA) in patients with esophageal cancer in 2009. By June 2013, 140 patients had undergone LTHA by our method. The main advantage of this method is the simplification of thoracic procedures conventionally performed via thoracotomy; the quality of the mediastinal surgery is also superior. Here, we report 2 cases of esophageal cancer in which we successfully performed salvage esophagectomy using LTHA. Patient 1 was a 57-year old man with persistent thoracic esophageal cancer after definitive chemoradiotherapy (dCRT). Subtotal esophagectomy via LTHA was performed. A small right thoracotomy incision was made to extract the esophagus and allow for upper mediastinal lymphadenectomy. The operative time was 370 min, and 298 mL of intra-operative bleeding was recorded. The postoperative recovery was uneventful, and the patient was discharged 27 days after surgery. Patient 2 was a 64-year old man with severe esophageal stricture following dCRT for thoracic esophageal cancer. Subtotal esophagectomy by LTHA was performed without thoracotomy. The operative time was 282 min, and 125 mL of intra-operative bleeding was recorded. On the 23rd day after surgery, minor anastomotic leakage was noted. The leakage healed in response to drainage, and the patient was discharged 65 days after surgery. Our surgical procedure produced a good surgical view and made it possible to perform salvage esophagectomy safely.
authors.affiliation: Division of Digestive Surgery, Dept. of Surgery, Kyoto Prefectural University of Medicine.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiozaki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Konishi
authors.forename: Ryo
authors.initials: R
authors.lastname: Morimura
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Murayama
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kuriu
authors.forename: Hisashi
authors.initials: H
authors.lastname: Ikoma
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kubota
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Nakanishi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.forename: Chouhei
authors.initials: C
authors.lastname: Sakakura
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
mesh_terms: D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D016879:Salvage Therapy; D016896:Treatment Outcome