Thoracoscopic Reconstruction with the Non-Flap Tunnel Technique for Esophagogastric Junction Cancer Requiring High...

The double-flap technique (DFT) is an established anti-reflux reconstruction method after proximal gastrectomy (PG) and may be advantageous for mediastinal reconstruction because of its low incidence of anastomotic leakage. However, thoracoscopic DFT reconstruction remains technically demanding because flap-related procedures increase procedural complexity. The non-flap tunnel technique (NFTT) has recently been introduced as a simplified alternative to DFT, but its application in thoracoscopic mediastinal reconstruction has not been reported.

A 56-year-old man with Siewert type II esophagogastric junction cancer required a high intramediastinal anastomosis because a proximal submucosal tumor necessitated extended esophageal resection. After laparoscopic PG and lower esophagectomy, a seromuscular tunnel was created extracorporeally on the remnant stomach. The remnant stomach was elevated into the mediastinum, and thoracoscopic reconstruction was performed in the prone position. Following fixation of the remnant stomach to the esophagus and rotation of the esophagogastric axis, esophagogastrostomy was completed using hand-sewn sutures, followed by seromuscular roof closure over the anastomosis. Reconstruction was completed in 60 minutes. A contrast study on POD 5 demonstrated no anastomotic leakage or reflux. The patient resumed oral intake on POD 6 and was discharged on POD 11 without complications.

Thoracoscopic reconstruction using the NFTT is feasible and may represent a practical and technically simplified alternative to thoracoscopic DFT in selected patients requiring high intramediastinal anastomosis.