Pitfalls In Transthoracic Mobilization Of the Radiated Esophagus During Minimally Invasive Esophagectomy
Sebastien Gilbert, MD.
University of Ottawa, Ottawa, ON, Canada.
OBJECTIVE: Despite shortcomings in the literature supporting the routine use of neoadjuvant chemoradiation for esophageal cancer, this treatment approach is commonly recommended to patients. Therefore, an increasing number of minimally invasive esophagectomy candidates have received radiation to the thoracic esophagus. There can be significant variability in radiation exposure between patients with similar tumor location. This video illustrates 3 potential pitfalls when mobilizing an irradiated esophagus: 1) injury to the airway 2) perforation of the esophagus and 3) risk of injury to the aorta.
METHODS: Not applicable
RESULTS: This is the case of a 51 year-old man who was diagnosed with a uT3N1 adenocarcinoma of the distal esophagus. He received concurrent chemotherapy and radiation (45 Gy) to the tumor. Final pathology showed a small residual tumor (ypT1bN0). Forty-five lymph nodes were resected. The patient recovered well despite developing a left recurrent laryngeal nerve palsy. He remains recurrence-free at 16 months.
CONCLUSIONS: The risk of rare intraoperative complications of minimally invasive esophagectomy may be increased in patients who have received neoadjuvant chemoradiotherapy.
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