| Background: We developed a novel and simple technique for middle and lower mediastinal lymph node dissection (M&L LND) using a laparoscopic transhiatal approach (LTHA). Methods: By HALS, pericardial adipose tissue was divided, posterior plane of pericardium was extended, and anterior side of the subcarinal, main bronchial, thoracic paraaortic and pulmonary ligament LNs were separated. The posterior side of these LNs was then separated. Finally, while lifting LNs like a membrane, they were resected from bilateral mediastinal pleura, main bronchi and tracheal bifurcation. Results: 1) Patients performed M&L LND by LTHA (n=100, including thoracic esophageal cancer) were compared with those performed by right thoracotomy (n=75). The operative time and bleeding were decreased by LTHA. The number of resected M&L LNs was not different. Postoperative respiratory complications was significantly decreased (LHTA:13.0%, thoracotomy:25.3%). 2) Patients with EGJ cancers performed total mediastinal LND by thoracotomy were analyzed (n=37). Upper and/or middle mediastinal LNs metastasis was observed in 10 cases, and all of them had advanced tumors. All 6 cases with upper mediastinal LNs metastasis were SCC. Even in adenocarcinoma, middle mediastinal LN metastasis was observed in 2 cases, suggesting the importance of mediastinal LND for advanced EGJ cancers. Conclusions: Our surgical procedure resulted in a good surgical view, safe en-bloc mediastinal LND for EGJ cancers, and the decrease of postoperative respiratory complications. |
