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Modifications to total minimally invasive McKeown esophagectomy reconstructed through the retrosternal tunnel
Yawei Zhang, Yihua Sun, Hong Hu, Bin Li, Haiquan Chen.
Fudan University Shanghai Cancer Center, Shanghai, China.

OBJECTIVE: The aim of this study was to examine the morbidity, mortality, and efficacy of the modified minimally invasive McKeown esophagectomy (McKeown MIE) reconstructed through the retrosternal tunnel.
METHODS: Between February and June in 2013, 10 patients underwent such modified McKeown MIE. The patient was placed supine firstly. Gastric conduit was completed through laparoscopic mobilization. An end-to-end cervical esophagogastric anastomosis through the retrosternal tunnel was completed with a double-layer manual suture. A feeding nasogastric tube was placed through the pylorus. Then tumor resection and mediastinal lymphadenectomy was performed through the thoracoscopy.
RESULTS: There were 7 male and 3 female patients, with a mean age of 57 years (range, 47 to 63 years). 6 patients had tumor located in the upper thoracic esophagus and the other 4 in the middle. T stage was T1, T2, and T3 in 4, 3 and 3 patients, respectively. The mean number of lymph nodes harvested was 21. The mean postoperative hospital stay was 28 days. No major complication and hospital death occurred in this cohort except 2 anastomotic leaks.
CONCLUSIONS: McKeown MIE procedure with retrosternal reconstruction is a feasible and safe approach for thoracic upper and middle esophageal tumors, and also probably beneficial for postoperative treatment.

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