Reposition-free thoraco-laparoscopic surgery for EGJ cancer in the right hemilateral position

Esophagogastric junction (EGJ) cancer is becoming increasingly prevalent worldwide. Among surgical challenges, anastomotic leakage remains a significant concern. The optimal approach for Siewert type II tumors with an esophageal invasion of 2.1-4.0 cm is still debated. We employed a combined left thoracoscopic and laparoscopic approach with the patient in the right hemilateral position, enabling simultaneous thoracic and abdominal procedures without intraoperative repositioning.

We retrospectively reviewed patients with EGJ cancer and an esophageal invasion length of 2.1 to 4.0 cm who underwent the combined left thoracoscopic and laparoscopic approach between January 2021 and December 2024. Clinicopathological characteristics and surgical outcomes were evaluated and compared with those of patients treated with conventional laparoscopic transhiatal surgery during the same period.

Eight patients underwent the combined approach. Surgical procedures included six proximal gastrectomies with single-flap esophagogastrostomy and two total gastrectomies. Compared with 12 patients who underwent conventional laparoscopic surgery, no anastomotic leakage was observed in the combined group, whereas leakage occurred in the conventional group.

The combined left thoracoscopic and laparoscopic approach appears to be a feasible and safe option for EGJ cancer with esophageal invasion of 2.1-4.0 cm. No anastomotic leakage was observed, and this approach allows for stable anastomosis under direct visualization without repositioning.