Minimally Invasive Esophagectomy for Carcinoma of Esophagus After Neoadjuvant Chemoradiation
Daniel K. Tong*, Simon Law, Fion S. Chan, Kam H. Wong
Surgery, The University of Hong Kong, Hong Kong, Hong Kong
Minimally invasive esophagectomy in patients with esophageal cancer and prior chemoradiation is challenging because of post-radiation fibrosis. We present such a patient who was operated via combined thoracoscopy and laparoscopy.In the thoracic phase, the esophagus was mobilized together with mediastinal lymphadenectomy. In the abdominal phase, the stomach was mobilized with preservation of the vascular arcades. The cervical esophagus was divided and pulled down into the peritoneal cavity. Gastric transection was performed extracorporeally via a 5-cm mini-laparotomy. A narrowed gastric tube was created and railroaded via the orthotopic route to the neck for esophagogastric anastomosis.
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