Video-assisted thoracic surgery (VATS) hybrid esophagectomy after neoadjuvant treatment – case report
Journal
KOSOVA JOURNAL OF SURGERY
Date Issued
2023-03-01
Author(s)
Igor Dzikovski
Despot Despotovski
Faik Misimi
Marija Simonovska
Asaf Abdurahmani
Abstract
Esophageal cancer is an aggressive malignancy. It is 6 th among the leading
causes of cancer death and the 8 th most common cancer type worldwide.
Regarding gender distribution, esophageal cancer is about 2–4 times more
frequent among males than females. There are two main histological types;
esophageal squamous cell carcinoma is typically localized in the upper-
middle esophagus being the most frequent histological type and
adenocarcinoma subtype, usually localized in the lower esophagus. Over the
past two decades, video-assisted thoracic surgery (VATS) has revolutionized
how thoracic surgeons diagnose and treat esophageal diseases. Because of
the advancement of surgical laparoscopic and thoracoscopic procedures and
endoscopic instrumentation, minimally invasive esophagectomy (MIE) is
performed to enhance surgical outcomes and reduce surgical morbidity.
Here, we present a case of, video-assisted thoracic surgery hybrid
esophagectomy in a 63-year-old patient with esophageal cancer who had
received neoadjuvant therapy. Surgical technique: the patient was first
placed in the supine position under general anesthesia and double-lumen
intubation. An upper median laparotomy was performed to mobilize and
tubulate the stomach conduit. Then we continued with a left lateral
decubitus position; 4 cm incision was made in the 5th intercostal space to
accommodate the thoracoscopic instruments. The dissection and
mobilization of the esophagus were carried out from the esophageal hiatus
to the upper thoracic inlet after opening the posterior mediastinal pleura.
After this step, the stomach conduit was pulled-up through the esophageal
hiatus and laterolateral esophagogastric anastomosis was done in the chest.
The postoperative course ended without complications, and the patient was
discharged home on the 5th postoperative day. The, video-assisted thoracic
surgery hybrid approach is an excellent option for esophageal cancer
management, offering a quick recovery and low morbidity.
causes of cancer death and the 8 th most common cancer type worldwide.
Regarding gender distribution, esophageal cancer is about 2–4 times more
frequent among males than females. There are two main histological types;
esophageal squamous cell carcinoma is typically localized in the upper-
middle esophagus being the most frequent histological type and
adenocarcinoma subtype, usually localized in the lower esophagus. Over the
past two decades, video-assisted thoracic surgery (VATS) has revolutionized
how thoracic surgeons diagnose and treat esophageal diseases. Because of
the advancement of surgical laparoscopic and thoracoscopic procedures and
endoscopic instrumentation, minimally invasive esophagectomy (MIE) is
performed to enhance surgical outcomes and reduce surgical morbidity.
Here, we present a case of, video-assisted thoracic surgery hybrid
esophagectomy in a 63-year-old patient with esophageal cancer who had
received neoadjuvant therapy. Surgical technique: the patient was first
placed in the supine position under general anesthesia and double-lumen
intubation. An upper median laparotomy was performed to mobilize and
tubulate the stomach conduit. Then we continued with a left lateral
decubitus position; 4 cm incision was made in the 5th intercostal space to
accommodate the thoracoscopic instruments. The dissection and
mobilization of the esophagus were carried out from the esophageal hiatus
to the upper thoracic inlet after opening the posterior mediastinal pleura.
After this step, the stomach conduit was pulled-up through the esophageal
hiatus and laterolateral esophagogastric anastomosis was done in the chest.
The postoperative course ended without complications, and the patient was
discharged home on the 5th postoperative day. The, video-assisted thoracic
surgery hybrid approach is an excellent option for esophageal cancer
management, offering a quick recovery and low morbidity.
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