Mediastinoscopic esophagectomy for esophageal cancer
Esophageal cancer often spreads to the lymph nodes and is one of the most difficult diseases to cure. The esophagus is a tubular organ that connects the throat and stomach, so surgery for esophageal cancer usually requires thoracotomy.
Thoracotomy is highly invasive, so elderly patients and patients with poor respiratory function due to smoking are often physically unable to tolerate the surgery, or are at risk of developing postoperative complications, such as pneumonia.
The space between the left and right lungs in the chest is called the mediastinum, and contains the heart, large blood vessels, trachea, bronchi, thymus, nerves, and esophagus.
The esophagus is surrounded by these vital organs within the narrow mediastinum. It was previously difficult to perform surgery in the mediastinum without thoracotomy, but by introducing endoscopic technology into this field, it is now possible to perform endoscopic esophagectomy safely while viewing precise, detailed images gained from mediastinoscope (Fig. 1）.
Our approach for mediastinoscopic esophagectomy
Our department began performing mediastinoscopic esophagectomy in 2005, and has built up a track record of providing this procedure to patients who are unable to undergo thoracotomy, elderly patients with poor physical function, and patients with early-stage cancer.
In 2017, we introduced the pneumo-mediastinum technique, a method of expanding the space in which surgical procedures are performed by injecting carbon dioxide into the mediastinum, and since this surgical procedure became covered by national insurance in 2018, we have been working to improve the surgical technique in order to further reduce postoperative complications (Fig.2).
Mediastinoscopic esophagectomy is a highly difficult surgery, so there are only a limited number of facilities that can perform it. In our department, we are making efforts every day to further develop mediastinoscopic surgery by utilizing the surgical experience we have accumulated over many years.