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Mesenteric excision for esophageal cancer surgery: based on the concept of mesotracheoesophagus.

ABSTRACT: The fundamental principle of surgery for intestinal cancer is mesenteric excision. It has been widely accepted as radical surgery for colorectal cancer, and it comprises procedures such as complete mesocolic excision for colon cancer and total mesorectal excision for rectal cancer. So far, the concept of mesenteric excision of the esophagus has not been well documented, but our surgical experience with a magnified view using a thoracoscope and understanding of the surgical anatomy based on embryologic foregut development has led us to introduce the concept of mesotracheoesophagus. Using this concept, our technique is reproducible, effective, and safe for lymph node dissection along the left recurrent laryngeal nerve. Here we report our concept, procedure, and results of thoracoscopic esophageal cancer surgery.

SUBMITTER: Akagawa S

PROVIDER: S-EPMC6498365 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Mesenteric excision for esophageal cancer surgery: based on the concept of mesotracheoesophagus.

Akagawa Shin S Hosogi Hisahiro H Yoshimura Fumihiro F Kawada Hironori H Kanaya Seiichiro S

International cancer conference journal 20180514 4

The fundamental principle of surgery for intestinal cancer is mesenteric excision. It has been widely accepted as radical surgery for colorectal cancer, and it comprises procedures such as complete mesocolic excision for colon cancer and total mesorectal excision for rectal cancer. So far, the concept of mesenteric excision of the esophagus has not been well documented, but our surgical experience with a magnified view using a thoracoscope and understanding of the surgical anatomy based on embry ...[more]

PMID: 31149528

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Project description:BACKGROUND:The structures of the mesentery including adipose tissue, nerves, and lymphatics play an important role in the pathogenesis and disease progression of Crohn's disease (CD). Conventional surgical resection for CD usually does not involve resecting the mesentery en bloc with the specimen. This contrasts with complete mesocolic excision (CME) in colorectal cancer, which involves radical resection of the mesentery. Preliminary evidence from smaller studies suggests that applying the principle of mesocolic excision to CD surgery may reduce the risk of postoperative recurrence. This randomized controlled trial is designed to test whether applying the principles of mesocolic excision to CD results in reduced postoperative recurrence. It also aims to evaluate intra- and postoperative morbidity between the two approaches. METHODS:This international, multicenter, randomized controlled trial will randomize patients (n?=?116) scheduled to undergo primary ileocolic resection to either receive extensive mesenteric excision (EME) or conventional ileocolic resection with limited mesenteric excision (LME). Five sites will recruit patients in three countries. In the EME group, the mesentery is resected following CME, while avoiding the root region, i.e., 1?cm from the root of the ileocolic artery and vein. In the LME group, the mesentery is retained, i.e., "close shave" or?<?3?cm from the border of bowel. The primary end point will be surgical recurrence after surgery. The secondary end points will be the postoperative endoscopic and clinical recurrence, and intra- and postoperative morbidity. Demographics, risk factors, laboratory investigations, endoscopy, postoperative prophylaxis and imaging examination will be assessed. Analysis of the primary outcome will be on an intention-to-treat basis. DISCUSSION:If mesocolic excision in CD reduces postoperative disease recurrence and does not increase morbidity, this trial has the potential to change practice and reduce recurrence of CD after surgical resection. TRIAL REGISTRATION:Clinical Trials.gov, ID: NCT03769922. Registered on February 27, 2019.

Project description:BackgroundEsophagectomy for esophageal cancer is associated with a substantial risk of life-threatening complications and a limited long-term survival. This study aimed to clarify the controversial questions of how age influences short-term and long-term survival.MethodsThis population-based cohort study included almost all patients who underwent curatively intended esophagectomy for esophageal cancer in Sweden in 1987-2010, with follow-up through 2016. The exposure was age, analyzed both as a continuous and categorical variable. The probability of mortality was computed using a novel flexible parametric model approach. The reported probabilities are proper measures of the risk of dying, and the related odds ratios (OR) are therefore more suitable measures of association than hazard ratios. The outcomes were 90-day all-cause mortality, 5-year all-cause mortality, and 5-year disease-specific mortality. A novel flexible parametric model was used to derive the instantaneous probability of dying and the related OR along with 95% confidence intervals (CIs), adjusted for sex, education, comorbidity, tumor histology, pathological tumor stage, and resection margin status.ResultsAmong 1737 included patients, the median age was 65.6 years. When analyzed as a continuous variable, older age was associated with slightly higher odds of 90-day all-cause mortality (OR 1.05, 95% CI 1.02-1.07), 5-year all-cause mortality (OR 1.02, 95% CI 1.01-1.03), and 5-year disease-specific mortality (OR 1.01, 95% CI 1.01-1.02). Compared with patients aged < 70 years, those aged 70-74 years had no increased risk of any mortality outcome, while patients aged ≥ 75 years had higher odds of 90-day mortality (OR 2.85, 95% CI 1.68-4.84), 5-year all-cause mortality (OR 1.56, 95% CI 1.27-1.92), and 5-year disease-specific mortality (OR 1.38, 95% CI 1.09-1.76).ConclusionsPatient age 75 years or older at esophagectomy for esophageal cancer appears to be an independent risk factor for higher short-term mortality and lower long-term survival.

Dataset Information

Mesenteric excision for esophageal cancer surgery: based on the concept of mesotracheoesophagus.

Publications

Mesenteric excision for esophageal cancer surgery: based on the concept of mesotracheoesophagus.

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