Acta Medica Okayama volume74 issue6
2020-12 発行

Bilateral Approach for Thoracoscopic Esophagectomy in a Patient with Esophageal Cancer and Solitary Posterior Thoracic Para-aortic Lymph Node Metastasis

Itazaki, Yujiro Department of Surgery, National Defense Medical College
Tsujimoto, Hironori Department of Surgery, National Defense Medical College
Sugasawa, Hidekazu Department of Surgery, National Defense Medical College
Yaguchi, Yoshihisa Department of Surgery, National Defense Medical College
Nomura, Shinsuke Department of Surgery, National Defense Medical College
Ito, Nozomi Department of Surgery, National Defense Medical College
Harada, Manabu Department of Surgery, National Defense Medical College
Sugihara, Takao Department of Surgery, National Defense Medical College
Tsuchiya, Satoshi Department of Surgery, National Defense Medical College
Ishibashi, Yusuke Department of Surgery, National Defense Medical College
Kouzu, Keita Department of Surgery, National Defense Medical College
Kishi, Yoji Department of Surgery, National Defense Medical College
Ueno, Hideki Department of Surgery, National Defense Medical College
Publication Date
2020-12
Abstract
We report a successful dissection of metastatic posterior thoracic para-aortic lymph node (No. 112aoP) via bilateral thoracoscopic surgery. With the anesthetized patient (a 73-year-old Japanese woman) in the prone position, two working ports were inserted for the left-side approach, and artificial pneumothorax was created. Thoracoscopic examination revealed a swollen LN posterior to the descending aorta. Fat and metastatic LNs posterior to the aorta were dissected from the aortic arch level to the diaphragm while preserving intercostal arteries. For the right-side approach, two working ports were inserted and a routine thoracoscopic esophagec-tomy was performed. Gastric conduit reconstruction was achieved laparoscopically. Operation time for the left thoracic procedure: 54 min; estimated blood loss: almost none. No recurrence was detected 24 months post-operatively. There are several surgical options for approaching No. 112aoP, including transhiatal, left thora-cotomy, and thoracoscopy. Although a wide dissection of the posterior thoracic para-aortic area has not been reported, it may be feasible and safe if the artery of Adamkiewicz and intercostal arteries are preserved. A min-imally invasive bilateral thoracoscopic approach for a thoracoscopic esophagectomy is safe and useful for esophageal cancer patients with solitary No. 112aoP metastasis.
Document Type
Case Report
Keywords
bilateral approach
posterior thoracic para-aortic lymph node
thoracoscopic esophagectomy
Link to PubMed
74_6_521.pdf 7.81 MB