Novel minimally invasive approach to lymph node dissection around the left renal vein in patients with esophagogastric j
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Novel minimally invasive approach to lymph node dissection around the left renal vein in patients with esophagogastric junction cancer Hiroyuki Daiko1,2 · Takeo Fujita2 · Junya Oguma1 · Takuji Sato2 · Ataru Sato1 · Kazuma Sato2 · Yuki Hirano1 · Daisuke Kurita1 · Koshiro Ishiyama1 · Hisashi Fujiwara2 Received: 15 September 2020 / Accepted: 20 September 2020 © The Japan Esophageal Society 2020
Abstract The left renal vein lymph node (LRVLN) may be the extended locoregional node in esophagogastric junction cancer; however, only open-surgical methods of dissection have been reported. We therefore developed a novel minimally invasive laparoscopic method for LRVLN dissection. Following esophagectomy, the stomach was mobilized and LRVLN dissection was started by taping the pancreatic body using two silicone drains. The transverse mesocolon was then retracted through the superior duodenal fossa to expose the horizontal duodenum and permit LRVLN dissection. We carried out the procedure successfully in 17 patients with advanced esophagogastric cancer. The median total and laparoscopic operative times were 415 and 161 min, respectively. Postoperative esophagectomy-related complications occurred in six patients. The median estimated blood loss was 120 ml and hospital stay was 15 days. This minimally invasive laparoscopic LRVLN dissection method was safe and effective, and may support faster recovery and earlier postoperative adjuvant therapy in patients with esophagogastric junction cancer. Keywords Minimally invasive surgery · Para-aortic lymph node · Esophagogastric junction
Introduction Esophagogastric junction carcinoma has characteristics of both esophageal and gastric carcinomas, and the esophagogastric junction has direct lymphatic pathways into the left renal vein (LRV) area [1]. The LRV lymph node (LRVLN) is the recognized extended locoregional node for the esophagogastric junction, and surgical resection of the LRVLN may thus improve locoregional control. Surgical resection is the standard treatment for esophageal and gastric cancers, and minimally invasive techniques Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10388-020-00786-x) contains supplementary material, which is available to authorized users. * Hiroyuki Daiko [email protected] 1
Division of Esophageal Surgery, National Cancer Center Hospital, 5‑1‑1, Tsukiji, Chuo‑ku, Tokyo 104‑0045, Japan
Division of Esophageal Surgery, National Cancer Center Hospital East, Chiba, Japan
2
have been established [2, 3]; however, minimally invasive LRVLN dissection has rarely been reported [4], and no laparoscopic approach has yet been established. We describe a novel minimally invasive laparoscopic technique for lymph node dissection around the LRVLN via posterior side of the posterior side of the superior duodenal fossa, with pancreatic double-taping.
Surgical technique The surgical indication for the current technique was clinical T2 or over esophagogastric junction cancer, according to Nishi’
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