A Totally Laparoscopic Transhiatal Approach for Esophageal Cancer During Mediastinoscopic Esophagectomy.
- 1Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto City 6028566, Japan.
Abstract
Background
Mediastinoscopic esophagectomy is a minimally invasive approach that avoids thoracotomy and single-lung ventilation. We previously performed this procedure using hand-assisted laparoscopic surgery (HALS) and recently established a totally laparoscopic transhiatal approach. This retrospective, non-randomized study reported laparoscopic technique and compared the feasibility and surgical outcomes of these approaches.Methods
We retrospectively reviewed 262 patients who underwent radical mediastinoscopic esophagectomy using left cervical and transhiatal approaches at the Kyoto Prefectural University of Medicine between January 2020 and June 2026. HALS was performed in 202 patients and laparoscopy in 60 patients. Surgical procedures and perioperative outcomes were compared between the groups.Results
Blood loss and total operative time did not differ significantly between the groups, although the transhiatal procedure tended to require a longer operative time with laparoscopy (p = 0.09). The approach used for middle mediastinal lymphadenectomy was similar between the two groups (43% vs. 35%, p = 0.28), and the overall number of dissected lymph nodes, excluding the upper mediastinal and cervical nodes, was comparable. However, significantly more abdominal lymph nodes were dissected with laparoscopy than with HALS (17.9 vs. 15.7, p = 0.04). Laparoscopic gastric mobilization and lymph node dissection were safely performed, with no significant differences in the rate of postoperative complications or curability.Conclusions
The totally laparoscopic transhiatal technique is a feasible and safe approach for mediastinoscopic esophagectomy, with surgical outcomes comparable to those of HALS and not inferior abdominal lymph node dissection. It may be particularly advantageous for cases requiring meticulous abdominal lymphadenectomy.
Related
- Inflatable mediastinoscopic esophagectomy for refractory benign esophageal fistulas: An effective therapeutical methods
- Comparison of mediastinoscopic and thoracoscopic esophagectomy for esophageal cancer using matched cohorts of 152 cases
- Thoraco-laparoscopic versus open McKeown esophagectomy for esophageal cancer: comparative outcomes on inflammatory response and coagulation function
- Clinicopathological and Perioperative Factors Associated with Overall Survival and 90-Day Mortality Following Esophagectomy for Esophageal Cancer
- Late-onset thoracogastric airway fistula after esophagectomy for esophageal cancer: a narrative review
BibTeX
@article{konishi2026totally,
title = {{A Totally Laparoscopic Transhiatal Approach for Esophageal Cancer During Mediastinoscopic Esophagectomy.}},
author = {Hirotaka Konishi and Shutaro Sumiyoshi and Hiroyuki Inoue and Keiji Nishibeppu and Toshiyuki Kosuga and Yusuke Yamamoto and Ryo Morimura and Hitoshi Fujiwara and Atsushi Shiozaki},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18193236},
url = {https://europepmc.org/article/MED/42882930},
note = {CC BY},
}
RIS
TY - JOUR
TI - A Totally Laparoscopic Transhiatal Approach for Esophageal Cancer During Mediastinoscopic Esophagectomy.
AU - Hirotaka Konishi
AU - Shutaro Sumiyoshi
AU - Hiroyuki Inoue
AU - Keiji Nishibeppu
AU - Toshiyuki Kosuga
AU - Yusuke Yamamoto
AU - Ryo Morimura
AU - Hitoshi Fujiwara
AU - Atsushi Shiozaki
PY - 2026
DA - 2026/10/08
JO - Cancers
DO - 10.3390/cancers18193236
UR - https://europepmc.org/article/MED/42882930
AB - Background Mediastinoscopic esophagectomy is a minimally invasive approach that avoids thoracotomy and single-lung ventilation. We previously performed this procedure using hand-assisted laparoscopic surgery (HALS) and recently established a totally laparoscopic transhiatal approach. This retrospective, non-randomized study reported laparoscopic technique and compared the feasibility and surgical outcomes of these approaches.Methods We retrospectively reviewed 262 patients who underwent radical mediastinoscopic esophagectomy using left cervical and transhiatal approaches at the Kyoto Prefectural University of Medicine between January 2020 and June 2026. HALS was performed in 202 patients and laparoscopy in 60 patients. Surgical procedures and perioperative outcomes were compared between the groups.Results Blood loss and total operative time did not differ significantly between the groups, although the transhiatal procedure tended to require a longer operative time with laparoscopy (p = 0.09). The approach used for middle mediastinal lymphadenectomy was similar between the two groups (43% vs. 35%, p = 0.28), and the overall number of dissected lymph nodes, excluding the upper mediastinal and cervical nodes, was comparable. However, significantly more abdominal lymph nodes were dissected with laparoscopy than with HALS (17.9 vs. 15.7, p = 0.04). Laparoscopic gastric mobilization and lymph node dissection were safely performed, with no significant differences in the rate of postoperative complications or curability.Conclusions The totally laparoscopic transhiatal technique is a feasible and safe approach for mediastinoscopic esophagectomy, with surgical outcomes comparable to those of HALS and not inferior abdominal lymph node dissection. It may be particularly advantageous for cases requiring meticulous abdominal lymphadenectomy.
SN - 2072-6694
ER -