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Low-Cost Single-Port (LoCoSP) Device for a Transcervical Approach in Minimally Invasive Transhiatal Esophagectomy
Published on: September 11, 2021
Transhiatal surgical resection for adenocarcinoma of the cardia
M Carlini1, M T Lonardo, F Carboni
1Division of Digestive Surgery and Liver Transplantation, Regina Elena Institute for Cancer Research, Rome, Italy. maxcarlini@tiscali.it
Insights
Transhiatal esophagogastric resection is a feasible and effective surgical option for selected cardia adenocarcinoma patients, avoiding thoracotomy. This minimally invasive approach offers satisfactory oncologic outcomes and a safe alternative for treating this cancer.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Thoracic Surgery
Background:
- Cardia adenocarcinoma presents unique surgical challenges.
- Traditional surgical approaches often involve thoracotomy, which carries significant morbidity.
- Minimally invasive techniques are sought to improve patient outcomes.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of transhiatal esophagogastric resection for cardia adenocarcinoma.
- To assess the oncologic outcomes and safety of this surgical technique.
Main Methods:
- A retrospective review of 85 patients with cardia adenocarcinoma from 1981 to 2001.
- Focus on 34 patients undergoing transhiatal esophagogastric resection (Pinotti's technique) since 1994.
- Inclusion criteria: Siewert II-III classification, T1-3 tumors, and clinically negative mediastinal lymph nodes.
Main Results:
- The transhiatal approach allowed satisfactory esophageal mobilization and mediastinal dissection without thoracotomy.
- Postoperative complications occurred in 24% of patients (11.8% medical, 11.8% surgical).
- Mortality rate was 11.8% (8.8% local complications, 2.9% cardiac failure).
- 1- and 2-year locoregional recurrence rates were 8.8% and 11.8%, respectively.
- 5-year overall survival was 22.5%.
Conclusions:
- Transhiatal esophagogastric resection is technically feasible and safe for selected cardia cancer patients.
- The procedure provides adequate esophageal resection and mediastinal lymphadenectomy.
- It represents a viable alternative to thoracotomy, potentially improving patient recovery.
Abstract:
Aim of this study is to define feasibility and effectiveness of the transhiatal esophagogastric resection in cardia adenocarcinoma. From 1981 to 2001, we submitted to surgery 85 patients affected by cardia adenocarcinoma. Since 1994, 34 patients, in consideration of clinical, anatomosurgical (Siewert II-III) and pathologic (T1-3, cN mediastinal negative) findings, underwent transhiatal esophagogastric resection according to Pinotti's technique. This consisted in the midline opening of the central tendon of the diaphragm, ligature and section of the left inferior phrenic vessels, exposure and anterior retraction of the pericardium. The approach allowed in all cases a satisfactory esophageal mobilization and a good dissection of the inferior mediastinal structures avoiding thoracotomy. Postoperative complications were observed in 8 patients (24%). In 4 cases the complications were medical (11.8%) and in 4 cases surgical (11.8%). Death occurred in 4 cases (11.8%): in 3 patients (8.8%) for local complications (2 anastomotic leaks and 1 hemorrage) and in 1 (2.9%) for cardiac failure. The 26 non complicated cases had an uneventful postoperative course and were discharged 12 days after surgery. Middle and long term results were evaluated in terms of locoregional recurrence rate and actuarial survival. At 1 and 2 years locoregional recurrence occurred in 8.8% and 11.8% of cases respectively. Five-year overall survival was 22.5%. In selected cases (Siewert type II-III, T1-3 tumors with clinically negative mediastinal lymphnodes) the procedure in study appears technically feasible, it provides a satisfactory volume of esophageal exeresis and an adequate extension of mediastinal lymphadenectomy, representing a safe and effective alternative to thoracotomy in cardia cancer surgery.
