Minimally invasive esophagogastrectomy for esophagogastric junctional cancer.

Background. Because surgery for esophagogastric junctional cancer (EGJC) occasionally requires a thoracotomy in addition to a laparotomy, surgery is associated with high mortality and morbidity rates. Therefore, minimally invasive surgery should be developed as an alternative to conventional open surgery. Methods. We herein describe our first series of seven patients with EGJC who were treated by minimally-invasive surgery using thoracoscopy in addition to the laparoscopic procedure. During the thoracoscopic procedures, transection of the esophagus was performed at the cancer-free portion with a dissection of lower mediastinal nodes and a side-to-side Roux-en-Y esophagojejunostomy was made intrathoracically. Results. In the seven patients treated using this procedure, the mean total length of the operation was 606 minutes and the mean number of retrieved lymph nodes was 58. No adverse events occurred intraoperatively and no failure in the intrathoracic esophagojejunostomy was observed, and favorable short-term results were obtained. Conclusions. The described procedure for the treatment of patients with EGJC is a minimally invasive alternative to conventional open surgery that looks promising. (Ann Thorac Surg 2012; 93:214-20) (C) 2012 by The Society of Thoracic Surgeons