Thoracoscopic radical esophagectomy and laparoscopic transhiatal lymph node dissection for superficial esophageal cancer associated with lymph node metastases in the dorsal area of the thoracic aorta

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• 作者：Itasu Ninomiya ; Koichi Okamoto ; Tomoya Tsukada ; Hiroto Saito…
• 关键词：Esophageal cancer ; Lymphatic metastasis ; Video ; assisted surgery ; Thoracic ; aorta
• 刊名：Surgical Case Reports
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：1
• 期：1
• 全文大小：3245KB
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• 作者单位：Itasu Ninomiya (1)
  Koichi Okamoto (1)
  Tomoya Tsukada (1)
  Hiroto Saito (1)
  Sachio Fushida (1)
  Hiroko Ikeda (2)
  Tetsuo Ohta (1)
  
  1. Gastroenterologic Surgery, Department of Oncology, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
  2. Section of Diagnostic Pathology, Kanazawa University Hospital, Kanazawa, Ishikawa, 920-8641, Japan
  
• 刊物类别：Surgery;
• 刊物主题：Surgery;
• 出版者：Springer Berlin Heidelberg
• ISSN：2198-7793

文摘

Esophageal cancer invading the muscularis mucosa sometimes involves regional lymph node metastases. However, lymph node metastases are rare in the dorsal area of the thoracic aorta. We describe a patient with an intramucosal esophageal cancer invading the muscularis mucosa, accompanied by lymph node metastases in the dorsal area of the thoracic aorta. These lesions were successfully resected by hand-assisted laparoscopic surgery using a transhiatal approach. A 60-year-old man was diagnosed with superficial esophageal cancer during a routine health examination. Endoscopic examination and ultrasonography revealed a superficial cancer, of diameter 6.0 cm, invading the submucosal layer and intramural metastases caudal to the primary tumor. Enhanced computed tomography and F-deoxyglucose positron emission tomography demonstrated the two metastatic lymph nodes, one in the dorsal area of the thoracic aorta and the other near the left gastric artery. Thoracoscopic radical esophagectomy with three-field lymph node dissection was performed. The metastatic lymph node in the dorsal area of the thoracic aorta was successfully removed by hand-assisted laparoscopic surgery using a transhiatal approach. Histopathological examination showed primary cancer invading the muscularis mucosa and intramural metastases in the lamina propria mucosa and submucosal layer. The pathological diagnosis according to the Japanese classification of esophageal cancer was MtLt, 47 mm, 0-IIa鈥?鈥塈Ib, pT1a-MM, ie(+), INF-b, ly3, v0, pN4(4a), pIM1, M0, and pstage IVa. The patient underwent two courses of adjuvant chemotherapy, consisting of CDDP and 5-fluorouracil. At present, 1 year and 8 months after surgery, the patient remains alive without tumor recurrence. Although the lymph node in the dorsal area of the thoracic aorta is not recognized as regional nodes of thoracic esophageal cancer, solitary mediastinal metastases from a mucosal cancer may indicate the existence of direct lymphatic flow from the thoracic esophagus to the retroaortic region. Transhiatal approach by hand-assisted laparoscopic surgery is useful to dissect the metastatic lymph node in the dorsal area of the thoracic aorta. Keywords Esophageal cancer Lymphatic metastasis Video-assisted surgery Thoracic-aorta