gms | German Medical Science

Background: As one of the leading hospitals for the treatment of esophageal cancer in Japan, we have developed since 2008 the minimal-invasive thoraco-laparoscopic esophagectomy as the standard surgical procedure in our division, which is conducted as a part of the multimodal therapy. We perform the thoracoscopic esophagectomy with the three field lymphadenectomy in the prone position, following the laparoscopic assisted gastric pull-up with the cervical anastomosis as the reconstruction.

Materials and methods: Since 2008, we have enhanced the indication for this operation gradually according to TNM-classification. Currently the thoracoscopic esophagectomy is indicated for all cases except of a suspected T4-tumor. The laparoscopic-assisted reconstruction is indicated for all cases without a history of an extended abdominal open surgery.

Results: In 2014, more than 70% of all patients treated in our division (164 patients) underwent the thoracoscopic esophagectomy. In total, we performed 312 cases of thoracoscopic esophagectomy beween 2008 and 2014. The conversion rate to an open surgery was only 12 cases since 2008, due to adhesion, infiltration to the neighborhood or intraoperative organ injury. The in-hospital mortality rate was 0.3%. The anastomotic leakage was diagnosed in 14.9% of the cases, which were all successfully treated by the conservative therapy. The paralysis of the recurrent laryngeal nerve was observed in 12.9% of the cases. The mean operation time was 366 minutes.

Conclusion: As one of the pioneers in this field in Japan, I am convinced that this procedure is advantageous compared to the conventional open surgery, as it allows the exact identification and preparation of microanatomical structures using optical magnification through the thoracoscopy. Thus, I would like to introduce our technique as one of the approaches to the minimal invasive surgical therapy of esophageal cancer and discuss it with specialists from Germany.