Bilateral approach for thoracoscopic esophagectomy with lymph node dissection in the dorsal area of the thoracic aorta in patients with esophageal cancer: A report of two cases

Yu Onodera, Toru Nakano, Takahiro Heishi, Tadashi Sakurai, Yusuke Taniyama, Chiaki Sato, Noriaki Ohuchi, Takashi Kamei

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction The incidence of lymph node metastasis in the dorsal area of the thoracic aorta (DTA) is relatively low in patients with esophageal cancer. It is difficult to approach the DTA using surgical procedures, such as an open thoracotomy and thoracoscopy in the left decubitus position. Case presentation Case 1: A 70-year-old man with esophageal cancer underwent thoracoscopic esophagectomy with mediastinal lymph node dissection via a right thoracoscopic approach, followed by lymphadenectomy in the DTA via left thoracoscopy in the prone position. Microscopic findings revealed two metastatic lymph nodes in the DTA. The definitive diagnosis was squamous cell carcinoma of the esophagus, and the pathological stage was T2N3M0 (Union for International Cancer Control [UICC], 7th edition). The patient showed lung metastasis 8 months after the surgery. Case 2: A 72-year-old man with esophageal cancer underwent esophagectomy via a bilateral approach in the prone position, using a similar procedure as in case 1. The definitive diagnosis was squamous cell carcinoma of the esophagus, and the pathological stage was T3N2M0. The patient showed a metastatic mediastinal lymph node 4 months after the surgery. Conclusion Bilateral thoracoscopic esophagectomy in the prone position can be safely performed, and it might be an alternative curative surgery for esophageal cancer. However, both our cases showed metastasis in the early postoperative period. The long-term outcome and significance of dissection of lymph nodes in the DTA in patients with esophageal cancer remains controversial. Further studies are required to establish the indications and efficacy of this therapeutic approach.

Original languageEnglish
Pages (from-to)154-158
Number of pages5
JournalInternational Journal of Surgery Case Reports
Volume31
DOIs
Publication statusPublished - 2017

Keywords

  • Esophagus
  • Left thoracic cavity
  • Lymph node metastasis
  • Thoracoscopic esophagectomy
  • Thoracoscopy

ASJC Scopus subject areas

  • Surgery

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