Video-assisted surgery for gastric carcinoma arising in a gastric tube reconstructed retrosternally

Abstract

Advances in diagnostic and surgical techniques have improved the prognosis of esophageal cancer, but there is growing concern about gastric tube cancer after esophagectomy. Gastric carcinoma arising in tubes that were reconstructed retrosternally is usually resected through a median sternotomy; however, this is invasive and carries a risk of osteomyelitis after suture-line failure. We performed video-assisted gastric tube resection, eliminating the need for sternotomy by using a sternal lifting method, on a 71-year-old man who had previously undergone esophagectomy and reconstruction retrosternally. The tumor was a Borrmann type 1 advanced cancer located near the esophagogastric anastomosis. Neck collar and upper abdominal incisions were made, and the sternum was lifted using a Kent retractor to extend the retrosternal space. Under videoscope assistance, we stripped the adhesions around the gastric tube carefully and performed total gastric tube resection. For the reconstruction, the ileocolon was lifted through the retrosternal space, and an ileoesophagostomy and Roux-en-Y reconstruction were performed. Despite leakage from an esophago-ileoanastomosis on postoperative day 6, the patient recovered well without mediastinitis or osteomyelitis of the sternum. Thus, our surgical procedure provides a good surgical view, decreases surgical stress, and reduces the risk of fatal postoperative complications.

Laparoscopic mediastinal approach for retrosternal gastric conduit cancer after esophagectomy

“…Moreover, gastric conduit cancer occurs approximately 7 years after esophagectomy, especially in older patients with a higher risk of perioperative complications 3,4 . This successful surgical approach supports previous reports, 9,10 in which video‐assisted gastric conduit resection was performed, and suggests the safety of this procedure in avoiding sternotomy.…”

A novel laparoscopic assisted mediastinal dissection with gastric tube inversion technique for gastric tube cancer reconstructed through a retrosternal route

“…Some authors have reported a radical surgical procedure for gastric tube cancer reconstructed through the retrosternal route without a sternotomy. 7 , 8 , 9 , 10 The approaches described in these reports were mainly classified as laparoscopic mediastinal and thoracoscopic approaches.…”

“…Recently, although there have been some reports of procedures without a median sternotomy for patients with retrosternal gastric tube cancer, nearly all of the reports only involve single cases. 7 , 8 , 9 , 10 …”

Case report: Gastric tube cancer after esophagectomy—Retrograde perfusion after proximal resection of right gastroepiploic artery

“…Sternotomy in particular has a high incidence of severe morbidities such as anastomotic leakage, sternal osteomyelitis, and colon conduit necrosis. Use of video-assisted total resection of the gastric tube as an alternative to sternotomy has been reported [14,15]. However, if technically feasible, partial resection is the best option, as it precludes severe postoperative complications and reduces perioperative risk.…”