Acta Medica Okayama 74巻 6号
2020-12 発行
Itazaki, Yujiro
Department of Surgery, National Defense Medical College
Tsujimoto, Hironori
Department of Surgery, National Defense Medical College
Sugasawa, Hidekazu
Department of Surgery, National Defense Medical College
Yaguchi, Yoshihisa
Department of Surgery, National Defense Medical College
Nomura, Shinsuke
Department of Surgery, National Defense Medical College
Ito, Nozomi
Department of Surgery, National Defense Medical College
Harada, Manabu
Department of Surgery, National Defense Medical College
Sugihara, Takao
Department of Surgery, National Defense Medical College
Tsuchiya, Satoshi
Department of Surgery, National Defense Medical College
Ishibashi, Yusuke
Department of Surgery, National Defense Medical College
Kouzu, Keita
Department of Surgery, National Defense Medical College
Kishi, Yoji
Department of Surgery, National Defense Medical College
Ueno, Hideki
Department of Surgery, National Defense Medical College
We report a successful dissection of metastatic posterior thoracic para-aortic lymph node (No. 112aoP) via bilateral thoracoscopic surgery. With the anesthetized patient (a 73-year-old Japanese woman) in the prone position, two working ports were inserted for the left-side approach, and artificial pneumothorax was created. Thoracoscopic examination revealed a swollen LN posterior to the descending aorta. Fat and metastatic LNs posterior to the aorta were dissected from the aortic arch level to the diaphragm while preserving intercostal arteries. For the right-side approach, two working ports were inserted and a routine thoracoscopic esophagec-tomy was performed. Gastric conduit reconstruction was achieved laparoscopically. Operation time for the left thoracic procedure: 54 min; estimated blood loss: almost none. No recurrence was detected 24 months post-operatively. There are several surgical options for approaching No. 112aoP, including transhiatal, left thora-cotomy, and thoracoscopy. Although a wide dissection of the posterior thoracic para-aortic area has not been reported, it may be feasible and safe if the artery of Adamkiewicz and intercostal arteries are preserved. A min-imally invasive bilateral thoracoscopic approach for a thoracoscopic esophagectomy is safe and useful for esophageal cancer patients with solitary No. 112aoP metastasis.
bilateral approach
posterior thoracic para-aortic lymph node
thoracoscopic esophagectomy