Current status of high-positioned digestive tract reconstruction after laparoscopic proximal stomach and lower esophagus resection through the abdominal-left diaphragmatic approach for adenocarcinoma of esophagogastric junction
Journal Title: Journal of Surgery : Concepts & Practice - Year 2023, Vol 28, Issue 3
Abstract
In recent years, the rising incidence of adenocarcinoma of esophagogastric junction (AEG) and the subsequent surge in early detections have transformed the surgical treatment of AEG into a topic of substantial interest. The anatomical positioning of AEG, combined with the unique nature of its tumor biology, which encompasses two distinct surgical domains, the thoracic and abdominal cavities, has sparked numerous debates regarding the selection of treatment strategies. The comprehensiveness of lymph node dissection and the safety of digestive tract reconstruction are instrumental in shaping these strategies. The laparoscopic abdominal transhiatal (TH) approach offers a balance of addressing both these conside-rations. It ensures the oncological safety of inferior mediastinal lymph node dissection, while simultaneously performing abdominal lymph node dissection. This approach becomes a prime choice for AEG when the esophageal invasion length is ≤ 4 cm.When implementing the TH approach, surgeons have the ability to either augment the inferior mediastinal space or establish a direct connection between the abdomen and the left thoracic cavity by performing a strategic opening of the left diaphragm. Such a maneuver circumvents the need for traditional thoracotomy, thus enlarging the operating space and enhancing the surgical field of view. This method reduces chest trauma and enables a clearer and more comprehensive removal of inferior mediastinal lymph nodes. Moreover, ample operating space and sufficient esophageal dissection make high digestive tract reconstruction in the mediastinum or left thoracic cavity safer and more feasible. Our center has dubbed this approach the abdominal-left diaphragmatic (ALD) approach. Functional digestive tract reconstructions such as side overlap esophagogastrostomy （SOFY） anastomosis and double-flap technique can be progressively applied to a higher anastomosis plane through the ALD approach. Consequently, the ALD approach expands the indications for digestive tract reconstruction, ensures operational safety, and maintains an effective anti-reflux effect simultaneously.
Authors and Affiliations
Wenqing HU, Yinhao YANG, Peng CUI, Wei WEI
Keywords
Related Articles
- EP ID EP750877
- DOI 10.16139/j.1007-9610.2023.03.009
- Views 25
- Downloads 0
Stage on development of pathophysiology of gallbladder stone and personalized diagnosis and treatment
Gallbladder stone (GS) is a common disease. There are no obvious symptoms at early stage for the patient with GS. Obstruction will cause acute cholecystitis. Secondary obstructive cholangitis of GS, biliary pancreatitis,...
Hereditary breast cancer risk gene assessment and counseling: interpretation of NCCN guidelines and Ruijin Hospital clinical practice
Hereditary breast cancer-related gene mutations significantly increase the risk of breast cancer in women. In this regard, the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Genetic/Familial...
Proceedings of clinical trials on bile tract cancer
Bile tract cancer (BTC) is aggressive and difficult to diagnose at an early stage. So far, radical surgery is the main curative measure for BTC, most patients with BTC are already in progressive or advanced stage at the...
New progression of radiomics in diagnosis of gastric cancer
Gastric cancer is a common entity of malignant tumor in China with the third cause of mortality and morbidity among all malignancies. In recent years, radiomics has emerged as a quantitative tool for imaging analysis wit...
Precision surgery in diagnosis and treatment of hepatocellular carcinoma