Requiring Multi-Steps During Minimally Invasive Surgery

Background: Transection of the esophagus at a cancer-negative proximal surgical margin and alimentary tract reconstruction through the hiatus during minimally invasive surgery (MIS) may be complicated and difficult in some patients with Siewert type II or III esophagogastric junctional cancer (EGJC). In this study, we retrospectively determined requiring multi-steps during MIS for Siewert types II and III EGJC. Study Design: Fifty-one consecutive patients with surgically treated Siewert type II or III EGJC were reviewed from July 2006 to October 2016. Five patients were excluded, and the remaining forty-six patients were divided into four groups based on the combination of laparoscopic and thoracoscopic surgical procedures performed, according to Siewert classification and TNM-staging: one-step surgery (n = 16), twostep surgery without novel transection of the esophagus (n = 8), two-step surgery with novel transection of the esophagus (n = 13), and three-step surgery (n = 9). Results: The esophagus was transected successfully with a cancer-free proximal margin in all but one patient. However, only 16 patients (35 %) were treated successfully by laparoscopic surgery alone, and the remaining 30 patients needed one or more additional steps to complete the anastomosis after transection of the esophagus according to the extent of esophageal invasion of the tumor. Conclusion: Multi-step procedures may be needed to achieve a cancer-negative proximal margin followed by alimentary reconstruction during MIS in patients with Siewert type II or III EGJC.