Clinical advantage of transmediastinal esophagectomy in terms of postoperative respiratory complications.

Although the transmediastinal approach as a radical esophagectomy for esophageal carcinoma patients has attracted attention, its advantages over the transthoracic approach remain unclear. This study aimed to evaluate the efficacy of transmediastinal esophagectomy (TME) in terms of postoperative respiratory complications compared to that of open transthoracic esophagectomy (TTE). We reviewed patients with thoracic and abdominal esophageal carcinoma who underwent TME or TTE between February 2014 and November 2021. We compared postoperative respiratory complications as the primary outcome. The secondary outcomes included perioperative operation time, blood loss, postoperative complications, and the number of harvested mediastinal lymph nodes. Overall, 60 and 54 patients underwent TME and TTE, respectively. The baseline characteristics were similar between the two groups, except for age and histological type. There were no intraoperative lethal complications in either group. The incidence of respiratory complications was significantly lower in the TME group than in the TTE group (6.7 vs. 22.2%, p = 0.03). The TME group had a shorter operation time (403 vs. 451 min, p < 0.01), less blood loss (107 vs. 253 mL, p < 0.01), and slightly higher anastomotic leakage (11.7 vs. 5.6%, p = 0.33). The number of harvested lymph nodes was similar in both groups (24 vs. 26, p = 0.10). Multivariate analysis revealed that TME is an independent factor in reducing respiratory complications (odds ratio = 0.27, p = 0.04). TME for esophageal carcinoma was performed safely. TME was superior to TTE in terms of postoperative respiratory complications; however, the relatively higher frequency of anastomotic leakage should be considered and requires further evaluation.

Ogawa K ，Akashi Y ，Hisakura K ，Kim J ，Owada Y ，Ohara Y ，Enomoto T ，Furuya K ，Moue S ，Miyazaki Y ，Doi M ，Shimomura O ，Takahashi K ，Hashimoto S ，Oda T ... -  《-》

Utility for Postoperative Respiratory Function of Transmediastinal Esophagectomy for Esophageal Carcinoma.

Esophagectomy for esophageal carcinoma (EC) is known to lead to deterioration of respiratory function (RF) due to thoracotomy and mediastinal lymph node dissection. This study aimed to evaluate the impact of transmediastinal esophagectomy (TME) on pulmonary function. We retrospectively analyzed the data of 102 patients with EC who underwent transthoracic esophagectomy (TTE) or TME and underwent RF tests within three months postoperatively at Kyoto Prefectural University of Medicine between 2014 and 2022. Perioperative pulmonary functions were evaluated based on vital capacity (VC) and forced expiratory volume in one second (FEV1.0). Among 102 patients undergoing esophagectomy, 12 (11.8%) patients were included in the TTE group, and the remaining 90 (88.2%) patients were included in the TME group. Neoadjuvant treatments were significantly more common in the TTE group (p=0.011), with more advanced tumor stages (p=0.017). The TME group had significantly lower estimated blood loss (p=0.015). RF after esophagectomy showed a decrease in VC, and VC of predicted (%VC). The decrease rate in VC, %VC, and FEV1.0 was significantly greater in the TTE group than in the TME group. TME is a surgical procedure with a less severe postoperative decline in RF than TTE.

Sumiyoshi S ，Shiozaki A ，Fujiwara H ，Konishi H ，Inoue H ，Takabatake K ，Nishibeppu K ，Kiuchi J ，Imamura T ，Nanishi K ，Shimizu H ，Arita T ，Yamamoto Y ，Morimura R ，Kubota T ，Otsuji E ... -  《-》

[Application of mesoesophagus suspension technique in upper mediastinal lymph node dissection during thoracoscopic esophagectomy].

Zhang Z ，Song Q ，Lin J ，Kang M ... -  《-》

Short-term outcomes of robotic radical esophagectomy for esophageal cancer by a nontransthoracic approach compared with conventional transthoracic surgery.

Transthoracic esophagectomy (TTE) is believed to have advantages for mediastinal lymphadenectomy in the treatment of resectable esophageal cancer despite its association with a greater incidence of pulmonary complications and postoperative mortality. Transhiatal esophagectomy is regarded as less invasive, though insufficient in terms of lymph node dissection. With the aim of achieving lymph dissection equivalent to that of TTE, we have developed a nontransthoracic esophagectomy (NTTE) procedure combining a video-assisted cervical approach for the upper mediastinum and a robot-assisted transhiatal approach for the middle and lower mediastinum. We prospectively studied 22 accumulated cases of NTTE and verified feasibility by analyzing perioperative and histopathological outcomes. We compared this group's short-term outcomes with outcomes of 139 equivalent esophageal cancer cases operated on at our institution by conventional TTE (TTE group). In the NTTE group, there were no procedure-related events and no midway conversions to the conventional surgery; the mean operation time was longer (median, 524 vs. 428 minutes); estimated blood loss did not differ significantly between the two groups (median, 385 mL vs. 490 mL); in the NTTE group, the postoperative hospital stay was shorter (median, 18 days vs. 24 days). No postoperative pneumonia occurred in the NTTE group. The frequencies of other major postoperative complications did not differ significantly, nor were there differences in the numbers of harvested mediastinal lymph nodes (median, 30 vs. 29) or in other histopathology findings. NTTE offers a new radical procedure for resection of esophageal cancer combining a cervical video-assisted approach and a transhiatal robotic approach. Although further accumulation of surgical cases is needed to corroborate these results, NTTE promises better prevention of pulmonary complications in the management of esophageal cancer.

Mori K ，Yamagata Y ，Aikou S ，Nishida M ，Kiyokawa T ，Yagi K ，Yamashita H ，Nomura S ，Seto Y ... -  《-》

Long-term health-related quality of life following robot-assisted radical transmediastinal esophagectomy.

Sugawara K ，Yoshimura S ，Yagi K ，Nishida M ，Aikou S ，Yamagata Y ，Mori K ，Yamashita H ，Seto Y ... -  《-》