Minimally invasive hybrid surgery combined with endoscopic and thoracoscopic approaches for submucosal tumor originating from thoracic esophagus

World Journal of Surgical Oncology

Tomonori Yano¹  Yasuhiro Ohno¹  Satoshi Fujii²  Nobuyoshi Yamazaki³  Takahiro Ohgara³  Takeo Fujita³  Hiroyuki Daiko³ 

[1] Division of Gastrointestinal Endoscopy, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Chiba, Japan;Division of Clinical Pathology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Chiba, Japan;Division of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Chiba, Japan

关键词: Esophagoscopy;    Esophagus;    Gastrointestinal stromal tumor;    Thoracoscopy;    Submucosal tumor;   

Others  :  1131060
DOI  :  10.1186/s12957-015-0452-6

 received in 2014-06-19, accepted in 2015-01-08,  发布年份 2015

【 摘 要 】

Background

Despite the efficacy of molecular targeted therapy, surgical resection remains the only curative primary treatment for gastrointestinal stromal tumors (GISTs). However, in cases when the tumor originates from the thoracic esophagus, conventional transthoracic approach is highly invasive.

Methods

All procedures were performed with patients in a prone position through a double-lumen endotracheal tube for single-lung ventilation. First, to clarify the resection layer between the tumor and mucosal layer of the esophagus, a sodium hyaluronate solution colored with indigo carmine was injected into the submucosa via the esophagoscopic approach. Second, we thoracoscopically divided the longitudinal muscle of the esophagus and enucleated the tumor through three ports by dissecting along the artificially colored submucosa, thereby minimizing accidentally opening of the esophageal mucosa. Third, we sutured the divided longitudinal muscle layer and removed the tumor from the thoracic cavity.

Results

Four tumors, including one GIST, were successfully resected via this hybrid approach. The mean surgical time was 137.7 min (range, 60–231 min), and the mean blood loss was 21.2 ml (range, 3–65 ml). No perioperative complications occurred, including with accidental opening of the esophageal mucosa.

Conclusions

Our minimally invasive hybrid surgery combined with esophagoscopic and thoracoscopic approaches demonstrated successful resection. This surgery could have advantages both for curing esophageal submucosal tumor and for minimizing surgical invasiveness.

【 授权许可】

   
2015 Daiko et al.; licensee BioMed Central.

【 图 表 】

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