Prone position thoracoscopic-assisted total mesoesophageal excision: initial experiences and benefits of lymph node dissection

Chen, Chunji; Ding, Chengzhi; He, Yi; Guo, Xufeng

doi:10.1007/s00464-022-09704-x

Cited by 3 publications

(1 citation statement)

References 24 publications

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“…At the same time, study has found that the transcervical approach can completely remove the lymphatic chain along the recurrent laryngeal nerve at the cervicothoracic junction, which is helpful to improve the cure rate of surgery in patients with Siewert type II tumors ( 66 ). In terms of different surgical positions, Chen et al ( 67 ) used the prone position, and the results showed that the R0 resection rate was 93.4%, and the negative circumferential resection margin rate was 96.7%. The median total lymph node dissection rate was 21%, and the thoracic lymph node dissection rate was 13%.…”

Section: Selection Of Surgical Methods For Esophageal Cancer After Ne...mentioning

confidence: 99%

Surgical intervention after neoadjuvant therapy in esophageal cancer: a narrative review

Ke¹,

Xie²,

Liang³

et al. 2023

J Thorac Dis

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Background and Objective Esophageal cancer is one of the common malignant tumors in China. Previous studies have shown that surgery alone is less effective. Neoadjuvant therapy refers to preoperative chemoradiotherapy, which is the standard treatment for locally advanced and operable esophageal cancer. Selection of appropriate surgical methods and timing after neoadjuvant therapy is of great significance for improving the prognosis of patients and reducing postoperative complications. Methods An online electronic search of all eligible literature through PubMed, Google Scholar, and the Cochrane Library database was conducted using a combination of the following keywords: esophageal cancer, neoadjuvant therapy, neoadjuvant chemotherapy, chemoradiotherapy, immunotherapy, targeting, surgery, complications. With a focus on the use of surgery after neoadjuvant therapy, Eligible articles were identified by one or both authors. Key Content and Findings Neoadjuvant chemoradiotherapy combined with radical surgical resection remains the current standard of care for resectable esophageal cancer, significantly improving survival and pathologic complete response (PCR) compared with preoperative chemotherapy Recently, studies have also found that immunotherapy combined with chemotherapy has a more advantageous pathological response in patients with locally advanced disease. Although the emergence of targeted drugs has led to a change in treatment mode from traditional chemoradiotherapy to precision therapy, the postoperative progression-free survival (PFS) and overall survival (OS) need to be explored as well as how surgery-related risks caused by treatment can be reduced. Traditionally, surgery is performed 4–6 weeks after neoadjuvant therapy, and optimal timing for surgery after treatment is still being explored as research progresses, the surgical method also should be determined according to the specific situation of the patient. Postoperative complications should be dealt with in a timely manner, and of course, active preoperative intervention is equally important. Conclusions Neoadjuvant therapy combined with surgery is the gold standard for resectable esophageal cancer. However, optimal timing of surgery after preoperative treatment remains unclear. Minimally invasive thoracoscopic surgery (including robotic surgery) has gradually replaced traditional open surgery. Active prevention before operation, accurate and meticulous operation during operation, and timely treatment after operation can minimize the incidence of adverse events.

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Section: Selection Of Surgical Methods For Esophageal Cancer After Ne...mentioning

confidence: 99%

Surgical intervention after neoadjuvant therapy in esophageal cancer: a narrative review

Ke¹,

Xie²,

Liang³

et al. 2023

J Thorac Dis

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High cervical anastomosis reduces leakage-related complications after a McKeown esophagectomy

Chen,

Ding,

et al. 2024

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Anastomotic leak (AL) is one of the most serious complications after oesophageal cancer surgery. High cervical anastomosis using narrow gastric tube based on optimized procedures has the potential to reduce the AL after McKeown oesophagectomy. METHODS A narrow gastric tube was defined as 2–2.5 cm in diameter. Meanwhile, we defined high anastomosis (HA) and normal anastomosis (NA) based on the position of intraoperative cervical anastomosis above or below the level of the inferior thyroid artery, respectively. A total of 533 patients who received McKeown oesophagectomy from March 2018 to March 2023 were included in this study, including 281 patients in the NA group and 252 patients in the HA group. Potential confounding factors in baseline characteristics were balanced by propensity score matching (PSM). RESULTS After matching, 190 patients remained in both groups. In the comparison of pathological and surgical results, we found that the HA group harvested more lymph nodes in both total number (21.1 ± 10.0 vs.15.8 ± 7.7, p = 0.001) and thoracic part (13.5 ± 7.8 vs.10.8 ± 6.1, p = 0.005). The pathological T and TNM stage of patients in the HA group were earlier than those in the NA group (p = 0.001). Overall postoperative complications (p = 0.001), including pulmonary infection (p = 0.001), AL (p < 0.001), leakage related pyothorax (p < 0.001), recurrent laryngeal nerve palsy (p = 0.031), and pleural effusion (p < 0.001), were all significantly lower in the HA group. Finally, multivariable logistic regression analysis indicated that HA was an independent protective factor for AL (OR = 0.331, 95% CI: 0.166–0.658; p = 0.002). CONCLUSIONS For patients undergoing McKeown oesophagectomy, high cervical anastomosis using narrow gastric tube can effectively reduce leakage related complications.

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Early Contrast-Enhanced MR for Diagnosing Complete Tumor Response of Locally Advanced Esophageal Squamous Cell Carcinoma After Neoadjuvant Therapy: A Retrospective Comparative Study

Shi,

Yan,

Yang

et al. 2024

Ann Surg Oncol

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Prone position thoracoscopic-assisted total mesoesophageal excision: initial experiences and benefits of lymph node dissection

Cited by 3 publications

References 24 publications

Surgical intervention after neoadjuvant therapy in esophageal cancer: a narrative review

Surgical intervention after neoadjuvant therapy in esophageal cancer: a narrative review

High cervical anastomosis reduces leakage-related complications after a McKeown esophagectomy

Early Contrast-Enhanced MR for Diagnosing Complete Tumor Response of Locally Advanced Esophageal Squamous Cell Carcinoma After Neoadjuvant Therapy: A Retrospective Comparative Study

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