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. 2023 Apr 30;35(2):163-175.
doi: 10.21147/j.issn.1000-9604.2023.02.06.

Exploration and optimization of surgical techniques for laparoscopic transhiatal lower mediastinal lymph node dissection for adenocarcinoma of esophagogastric junction: A prospective IDEAL 2a study with qualitative design

Yinkui Wang  1 , Fanling Hong  1   2 , Shuangxi Li  1 , Fei Shan  1 , Yongning Jia  1 , Rulin Miao  1 , Zhemin Li  1 , Ziyu Li  1 , Jiafu Ji  1
Affiliations

Exploration and optimization of surgical techniques for laparoscopic transhiatal lower mediastinal lymph node dissection for adenocarcinoma of esophagogastric junction: A prospective IDEAL 2a study with qualitative design

Yinkui Wang et al. Chin J Cancer Res. .

Abstract

Objective: To explore the change and feasibility of surgical techniques of laparoscopic transhiatal (TH)-lower mediastinal lymph node dissection (LMLND) for adenocarcinoma of the esophagogastric junction (AEG) according to Idea, Development, Exploration, Assessment, and Long-term follow-up (IDEAL) 2a standards.

Methods: Patients diagnosed with AEG who underwent laparoscopic TH-LMLND were prospectively included from April 14, 2020, to March 26, 2021. Clinical and pathological information as well as surgical outcomes were quantitatively analyzed. Semistructured interviews with the surgeon after each operation were qualitatively analyzed.

Results: Thirty-five patients were included. There were no cases of transition to open surgery, but three cases involved combination with transthoracic surgery. In qualitative analysis, 108 items under three main themes were detected: explosion, dissection, and reconstruction. Revised instruction was subsequently designed according to the change in surgical technique and the cognitive process behind it. Three patients had anastomotic leaks postoperatively, with one classified as Clavien-Dindo IIIa.

Conclusions: The surgical technique of laparoscopic TH-LMLND is stable and feasible; further IDEAL 2b research is warranted.

Keywords: Adenocarcinoma of esophagogastric junction; IDEAL 2a research; laparoscopic surgery; lower mediastinal lymph node dissection; transhiatal approach.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Surgical process of LMLND. (A) Nathanson liver retractor was adjusted. LTL (white arrow) was not divided in this case; (B) Esophagus was denudated and retracted with tape; (C) Hiatus was split; (D) Dissection of the anterior esophagus and exposure of the pericardium (white arrow); (E) Dissection of the right side of the esophagus, with exposure of the infra-cardiac bursa (white arrow); (F) Dissection of the posterior esophagus. A lymph node is exposed (white arrow); (G) Dissection of the left side of the esophagus; (H) Dissection is complete, and a lymph node is exposed (white arrow). LMLND, lower mediastinal lymph node dissection.
Figure 2
Figure 2
Flowchart of patient inclusion. LMLND, lower mediastinal lymph node dissection.
See this image and copyright information in PMC

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