Cervical mediastinoscopy plus robot-assisted transhiatal esophagectomy (CMRTHE) for advanced esophageal cancer after neoadjuvant chemoradiation therapy: A technical note with video vignette
Journal
Asian Journal of Surgery
ISSN
1015-9584
0219-3108
Date Issued
2025-07
Author(s)
Abstract
Technique
Surgical management of esophageal cancer often involves a transthoracic approach. However, many patients have reduced pulmonary reserve due to a history of smoking. One-lung ventilation during transthoracic procedures complicates anesthesia and increases the risk of postoperative pulmonary complications. To address this, we developed cervical mediastinoscopy plus robot-assisted transhiatal esophagectomy (CMRTHE) as a nontransthoracic alternative. This novel procedure was further applied to patients with esophageal cancer after neoadjuvant concurrent chemoradiation therapy (CCRT). First, transcervical mediastinoscopy is applied, where the cervical/thoracic esophagus, left recurrent laryngeal nerve, and lymph nodes are carefully dissected through a single left neck incision. The operation then transitions to a transhiatal robotic approach following abdominal lymphadenectomy and stomach mobilization. Once the transcervical and transhiatal planes connect, CMRTHE is completed without one-lung ventilation. A video vignette is included to demonstrate the technique.
Results
A 58-year-old male with cT3N3 middle thoracic esophageal squamous cell carcinoma underwent neoadjuvant CCRT followed by CMRTHE. Despite some adhesions, the procedure was successfully completed and required 234 min for the transcervical mediastinoscopy and 71 min for the transhiatal robotic procedure. Blood loss was 220 mL. Pathology revealed a 2.5-cm residual tumor with clear margins, and none of the 21 lymph nodes showed metastasis. The patient's postoperative course was uneventful, with normal vocal cord function, and he was discharged on day 7.
Conclusions
CMRTHE is a technically feasible procedure for advanced esophageal cancer after neoadjuvant CCRT. However, further validation in a larger patient cohort is needed to assess its peri-operative and long-term oncological outcomes.
SDGs
Publisher
Asian Surgical Association and Taiwan Society of Coloproctology
Type
journal article