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Transhiatal laparoscopic esophagectomy with extended lymphadenectomy guided by green-indocyanine imaging for adenocarcinoma of the esophagogastric junction
Surgical Oncology 33 (2020) 30–31
Contents lists available at ScienceDirect
Surgical Oncology journal homepage: http://www.elsevier.com/locate/suronc
Transhiatal laparoscopic esophagectomy with extended lymphadenectomy guided by green-indocyanine imaging for adenocarcinoma of the esophagogastric junction Flavio Roberto Takeda *, Ulysses Ribeiro Junior, Rubens Antonio Aissar Sallum, Ivan Cecconello Department of Gastroenterology, Digestive Surgery Division, Sao Paulo Institute of Cancer, University of S~ ao Paulo Medical School, Brazil
A R T I C L E I N F O
A B S T R A C T
Keywords: Transhiatal Esophagectomy Indocyanine
Introduction: Surgical treatment for adenocarcinoma of the esophagogastric junction (AEGJ) has been longestablished, from resection margins to the extension of lymphadenectomy [1,2,4]. The addition of cyanine dye, namely indocyanine green (ICG), to identify suspicious lymph nodes (LN) and evaluate organ vasculari zation may improve results and outcomes [3]. Video: A 58-year-old female patient with Siewert type II AEGJ was administered mFLOX neoadjuvant treatment. After three cycles, she underwent surgical treatment. The day before surgery, an upper endoscopy was performed to inject 0.2 ml ICG 0.5 cm from the proximal and distal tumor margins. The patient underwent laparoscopic transhiatal esophagectomy with extended lymphadenectomy due to a 4 cm distal esophagus compromised margin. We describe the primary steps of the procedure and demonstrate the role of the ICG in the lymphadenectomy. Results: Surgery was carried out laparoscopically with a cervical approach (McKeown access), and posterior mediastinal gastric tube reconstruction and cervical gastroplasty were performed. During the standard lym phadenectomy, we observed an ICG-positive LN in station 10, which was found positive in the subsequent pa thology examination. After these findings, we performed an extended lymphadenectomy through the splenic hilum. The final pathologic assessment was T3N2 (two perigastric and one positive LN at station 10 among 60 retrieved LN). The operative time was 360 min. The patient started a liquid diet on the seventh postoperative day, and she was discharged on the tenth postoperative day. Conclusions: ICG may be helpful to guide both extended lymphadenectomy and distal margin evaluation in transhiatal laparoscopic esophagectomy.
Runtime of video 8mins and 8 sec.
Authorship statement
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
All authors have made substantial contributions to all of the following: (1)the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted.
Disclosure
Declaration of competing interests
Funding
Drs. Takeda FR, Ribeiro UR, Sallum RAA and Cecconello I have no conflicts of interest or financial ties to disclose.
The authors declare no competing financial interests.
* Corresponding author. E-mail address: [email protected] (F.R. Takeda). https://doi.org/10.1016/j.suronc.2019.12.009 Received 7 September 2019; Received in revised form 21 November 2019; Accepted 29 December 2019 Available online 2 January 2020 0960-7404/© 2020 Elsevier Ltd. All rights reserved.
F.R. Takeda et al.
Surgical Oncology 33 (2020) 30–31
Appendix ASupplementary data
[2] C. Okholm, K.T. Fjederholt, F.V. Mortensen, L.B. Svendsen, M.P. Achiam, The optimal lymph node dissection in patients with adenocarcinoma of the esophagogastric junction, Surg. Oncol. 27 (2018) 36–43. [3] O. Helminen, J. Mrena, E. Sihvo, Near-infrared image-guided lymphatic mapping in minimally invasive oesophagectomy of distal oesophageal cancer, Eur. J. Cardiothorac. Surg. 52 (2017) 952–957. [4] F.R. Takeda, F. Tustumi, B. Nigro, R. Sallum, U. Ribeiro, I. Cecconello, Transhiatal esophagectomy is not associated with poor quality lymphadenectomy, Arq. Bras. Cir. Dig. 32 (2019) e1475. In press.
Supplementary data to this article can be found online at https://doi. org/10.1016/j.suronc.2019.12.009. References [1] A.S. Borggreve, B.F. Kingma, S.A. Domrachev, M.A. Koshkin, J.P. Ruurda, R. van Hillegersberg, F.R. Takeda, L. Goense, Surgical treatment of esophageal cancer in the era of multimodality management, Ann. N. Y. Acad. Sci. 1434 (2018) 192–209.
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Contents lists available at ScienceDirect
Surgical Oncology journal homepage: http://www.elsevier.com/locate/suronc
Transhiatal laparoscopic esophagectomy with extended lymphadenectomy guided by green-indocyanine imaging for adenocarcinoma of the esophagogastric junction Flavio Roberto Takeda *, Ulysses Ribeiro Junior, Rubens Antonio Aissar Sallum, Ivan Cecconello Department of Gastroenterology, Digestive Surgery Division, Sao Paulo Institute of Cancer, University of S~ ao Paulo Medical School, Brazil
A R T I C L E I N F O
A B S T R A C T
Keywords: Transhiatal Esophagectomy Indocyanine
Introduction: Surgical treatment for adenocarcinoma of the esophagogastric junction (AEGJ) has been longestablished, from resection margins to the extension of lymphadenectomy [1,2,4]. The addition of cyanine dye, namely indocyanine green (ICG), to identify suspicious lymph nodes (LN) and evaluate organ vasculari zation may improve results and outcomes [3]. Video: A 58-year-old female patient with Siewert type II AEGJ was administered mFLOX neoadjuvant treatment. After three cycles, she underwent surgical treatment. The day before surgery, an upper endoscopy was performed to inject 0.2 ml ICG 0.5 cm from the proximal and distal tumor margins. The patient underwent laparoscopic transhiatal esophagectomy with extended lymphadenectomy due to a 4 cm distal esophagus compromised margin. We describe the primary steps of the procedure and demonstrate the role of the ICG in the lymphadenectomy. Results: Surgery was carried out laparoscopically with a cervical approach (McKeown access), and posterior mediastinal gastric tube reconstruction and cervical gastroplasty were performed. During the standard lym phadenectomy, we observed an ICG-positive LN in station 10, which was found positive in the subsequent pa thology examination. After these findings, we performed an extended lymphadenectomy through the splenic hilum. The final pathologic assessment was T3N2 (two perigastric and one positive LN at station 10 among 60 retrieved LN). The operative time was 360 min. The patient started a liquid diet on the seventh postoperative day, and she was discharged on the tenth postoperative day. Conclusions: ICG may be helpful to guide both extended lymphadenectomy and distal margin evaluation in transhiatal laparoscopic esophagectomy.
Runtime of video 8mins and 8 sec.
Authorship statement
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
All authors have made substantial contributions to all of the following: (1)the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted.
Disclosure
Declaration of competing interests
Funding
Drs. Takeda FR, Ribeiro UR, Sallum RAA and Cecconello I have no conflicts of interest or financial ties to disclose.
The authors declare no competing financial interests.
* Corresponding author. E-mail address: [email protected] (F.R. Takeda). https://doi.org/10.1016/j.suronc.2019.12.009 Received 7 September 2019; Received in revised form 21 November 2019; Accepted 29 December 2019 Available online 2 January 2020 0960-7404/© 2020 Elsevier Ltd. All rights reserved.
F.R. Takeda et al.
Surgical Oncology 33 (2020) 30–31
Appendix ASupplementary data
[2] C. Okholm, K.T. Fjederholt, F.V. Mortensen, L.B. Svendsen, M.P. Achiam, The optimal lymph node dissection in patients with adenocarcinoma of the esophagogastric junction, Surg. Oncol. 27 (2018) 36–43. [3] O. Helminen, J. Mrena, E. Sihvo, Near-infrared image-guided lymphatic mapping in minimally invasive oesophagectomy of distal oesophageal cancer, Eur. J. Cardiothorac. Surg. 52 (2017) 952–957. [4] F.R. Takeda, F. Tustumi, B. Nigro, R. Sallum, U. Ribeiro, I. Cecconello, Transhiatal esophagectomy is not associated with poor quality lymphadenectomy, Arq. Bras. Cir. Dig. 32 (2019) e1475. In press.
Supplementary data to this article can be found online at https://doi. org/10.1016/j.suronc.2019.12.009. References [1] A.S. Borggreve, B.F. Kingma, S.A. Domrachev, M.A. Koshkin, J.P. Ruurda, R. van Hillegersberg, F.R. Takeda, L. Goense, Surgical treatment of esophageal cancer in the era of multimodality management, Ann. N. Y. Acad. Sci. 1434 (2018) 192–209.
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