Minimally Invasive Esophagectomy for Siewert I Adenocarcinoma of the Gastroesophageal Junction

摘要

Adenocarcinoma of lower esophagus and GEJ shows worldwide an increasing incidence. Radical esophagectomy with extensive lymphadenec-tomy with open technique has high rate of morbidity and mortality. Recent advances in minimally invasive surgical technology have allowed surgeons to apply laparoscopy and thoracoscopy to perform esophagectomy. In the video we report the case of a 19 years-old man with Siewert I adenocarcinoma of GEJ who was submitted to a 3-stage minimally invasive esophagectomy by laparoscopy, right thoracoscopy and cervicotomy. Four ports were used for the abdominal approach. A complete mobilization of the stomach preserving the right gastroepiploic arcade was achieved. The patient was then turned to the left lateral decubitus position proned to 30?.Three ports were needed for right thoracoscopy. Mobilization of the thoracic esophagus was carried out from the diaphragm to the thoracic inlet. The stomach was pulled up to the neck and esophagogastric anastomosis with the Orringer technique was constructed through a left cervicotomy. Pathology showed pT3 pNl G3 adenocarcinoma.