Technical key points and short-term outcomes of fascia-guided radical esophagectomy: a single-center retrospective...

In recent years, the "concentric structural model" based on embryonic development and histologically confirmed periesophageal fascial layers has provided a new anatomical orientation for radical esophagectomy. However, a comprehensive evaluation of the technical key points and short-term outcomes of fascia-guided esophagectomy remains lacking. This study aims to elucidate the key technical aspects of this procedure and preliminarily assess its short-term safety and feasibility.

We retrospectively analyzed the clinical data of 88 patients with thoracic esophageal squamous cell carcinoma who underwent minimally invasive esophagectomy guided by fascial anatomy between January and December 2023. Utilizing the "concentric structural model" and histologically validated fascial planes, esophageal mobilization and en bloc lymph node dissection were performed along these anatomical planes in the upper, middle, and lower mediastinum, as well as the abdominal cavity. Postoperative pathological results and complications (graded using the Clavien-Dindo classification) were analyzed.

The cohort comprised 67 male patients (76.1%), with a mean age of 61.3 years and a mean BMI of 22.0 kg/m². Neoadjuvant therapy was administered to 49 patients (55.7%). The mean total operative time was 274.6 min, with a mean thoracic phase duration of 120.5 min. The mean estimated blood loss was 53.6 mL. The R0 resection rate was 97.7%. The mean total number of harvested lymph nodes was 51.1, with a mean of 38.0 lymph nodes retrieved from the thoracic region. The overall postoperative complication rate (Clavien-Dindo grade ≥ II) was 28.4%, and the major complication rate (Clavien-Dindo grade ≥ IIIa) was 14.8%. Specific complications included pneumonia (17.0%), recurrent laryngeal nerve palsy (10.2%), and anastomotic leakage (3.4%). The 90-day postoperative mortality rate was 1.1%.

Fascia-guided radical esophagectomy provides a clear anatomical dissection plane, facilitates en bloc lymph node dissection, and demonstrates acceptable short-term safety and feasibility, however, these findings warrant confirmation in larger, prospective, controlled studies with extended follow-up for oncologic outcomes.