Minimal invasive surgical therapy of early oesophageal cancer: totally laparoscopic transhiatal exstirpation

Peter Lukovich, Andras Papp, Peter Kupcsulik

1st Department of Surgery, Semmelweis University of Medicine, Budapest

Introduction: The minimal invasive exstirpation of the oesophagus is a real alternative to the conventional operation techniques in the surgery of oesophagus tumours.

Patient and method: 51 year-old female patient had endoscopy due to her vague stomach complaints. The examination found an oesophagus tumour of approximately 2 cm, located at 32 cm. EUS and CT examinations showed an early esophageal cancer which involved the submucosa, but no regional lymph node metastasis was detected. The intraluminal flexible endoscopic ablation (endoscopic submucosal dissection) of the tumour was not executed therefore totally laparoscopic transhiatal oesophagus exstirpation was done. The oesophagus was replaced intracorporally by the tubulated stomach in the posterior mediastinum.

Result: In the postoperative period a ventriculo-pleural fistula evolved in the middle third of the stomach which healed as a result of conservative treatment (thoracic drainage, Salem probe). The phlegmone which developed next to the feeding jejunostomy - at the place of a trocar - was healed, and later was sutured because of persisting leakage of the small intestine. 6 months after the operation the patient was asymptomatic and had taken up 4 kg.

Conclusion: The laparoscopic transhiatal oesophagus excision has all the advantages (less postoperative pain, early mobilisation, less pulmonary complication) of the minimal invasive method at the same time it makes it possible to do more radical operations than the traditional transhiatal operations.