559. SURGICAL PROCEDURE AND CLINICAL OUTCOME OF TRANSMEDIASTINAL ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

Abstract Background We started performing esophagectomy by a laparoscopic transhiatal approach in 2009, and 577 patients had undergone to date. Furthermore, we started performing single-port mediastinoscopic cervical approach in 2014, and developed a technique for total mediastinal lymph node dissection (390 patients). Methods The upper and middle mediastinal lymph node dissection including lymph nodes along the left recurrent laryngeal nerve, using a left cervical approach, was performed with a single-port mediastinoscopic technique. This approach with pneumomediastinum by AirSeal System improved the visibility and handling in the deep mediastinum around the aortic arch. We recently performed intraoperative monitoring of the recurrent laryngeal nerve using Nerve Integrity Monitor system. For dissection of upper and middle mediastinal lymph nodes, the left recurrent laryngeal nerve was sometimes compressed by the shaft of the sealing device or the retractor. We used continuous monitoring with the Automatic Periodic Stimulation electrode for the left recurrent laryngeal nerve, and immediately recognized dangerous procedures. Frequency of recurrent laryngeal nerve palsy was dramatically reduced to half by the introduction of Nerve Integrity Monitor system. Furthermore, to understand the anatomy of bilateral bronchial arteries, we performed 3-dimensional computed tomography angiography preoperatively, which was crucial to avoid intraoperative bleeding. Results The outcome of patients performed transmediastinal radical esophagectomy was compared with those performed the right thoracotomy by using propensity score matching. The operative time, the operative bleeding, and postoperative respiratory complications were significantly decreased by transmediastinal radical esophagectomy. Conclusion Our surgical procedure resulted in a good surgical view, safe en-bloc mediastinal lymph node dissection, and the decrease of postoperative respiratory complications. https://intconferenceservices-my.sharepoint.com/:v:/g/personal/barbarav_icsevents_com/ER9oAGbon3xJvdMGlJ2EUbIBgaq_8XDlKNA-wzVH3-7Hcg?nav=eyJyZWZlcnJhbEluZm8iOnsicmVmZXJyYWxBcHAiOiJPbmVEcml2ZUZvckJ1c2luZXNzIiwicmVmZXJyYWxBcHBQbGF0Zm9ybSI6IldlYiIsInJlZmVycmFsTW9kZSI6InZpZXciLCJyZWZlcnJhbFZpZXciOiJNeUZpbGVzTGlua0NvcHkifX0&e=KbAfDr