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Background: This study aimed to assess the surgical difficulty of minimally invasive esophagectomy in the left lateral decubitus position for patients with esophageal cancer from the perspective of short-term outcomes, including operation time, blood loss, and morbidity. Materials and methods: The initial 44 consecutive patients with esophageal cancer who underwent minimally invasive esophagectomy were statistically analyzed retrospectively. Thoracic cage area was measured from preoperative computed tomography as a factor affecting the surgical difficulty of minimally invasive esophagectomy, as well as other patient characteristics. Correlations with short-term outcomes including chest operation time, blood loss, and morbidity rate were then examined. Results: In univariate analyses, smaller area of the upper thoracic cage width correlated with prolonged thoracic procedure time (p = 0.0119) and greater blood loss during thoracic procedures (p = 0.0283), but area of the lower thoracic cage showed no correlations. History of respiratory disease was associated with thoracic procedure time (p < 0.0001), but not blood loss. In multivariate analysis, small area of the upper thoracic cage was independently associated with prolonged thoracic procedure time (p = 0.0253). Small upper thoracic cage area was not directly correlated with morbidity rate, but prolonged thoracic procedure time was associated with increased blood loss (p < 0.0001) and morbidity rate (p = 0.0204). Empirical time reduction (p = 0.0065), but not blood loss, was associated with thoracic procedure time. However, area of the upper thoracic cage did not correlate with empirical case number. In multivariate analysis, area of the upper thoracic cage (p = 0.0317) and empirical case number (p = 0.0193) correlated independently with thoracic procedure time. Conclusion: A small area of the upper thoracic cage correlated significantly with prolonged thoracic procedure time and increased thoracic blood loss for minimally invasive esophagectomy in the left lateral decubitus position, suggesting the surgical difficulty of minimally invasive esophagectomy in the left lateral decubitus position. [ABSTRACT FROM AUTHOR]

Introduction An esophagorespiratory fistula (ERF) can cause severe pneumonia or a lung abscess which progresses to life-threatening sepsis. A case of a patient with esophageal cancer and an esophagopulmonary fistula (EPF) who underwent separation surgery with drainage tube-less (DRESS) esophagostomy and was promptly started on definitive chemoradiotherapy (CRT) is reported. Presentation of case A 79-year-old man visited a clinic with a month-long history of dysphagia. Esophageal cancer at the middle thoracic esophagus was detected, and invasion of the left main bronchus and lower lobe of the right lung was seen on contrast-enhanced computed tomography (CT). Three weeks later, the patient was transferred to our hospital. CT showed a lung abscess in the lower lobe of the right lung that continued into the adjacent esophageal cancer. Due to the EPF, the patient underwent emergency surgery that consisted of esophageal separation surgery and double bilateral esophagostomy and enterostomy. Definitive CRT for the esophageal cancer was started from postoperative day 25. At six-month follow-up, the patient achieved relapse-free survival. Discussion Separation surgery with a DRESS esophagostomy provides good control of inflammation because of division of the respiratory tract from the alimentary tract, which allows prompt initiation of CRT. Alternatively, a DRESS esophagostomy allows patients to be free from any tube trouble. Conclusion Separation surgery with a DRESS esophagostomy for an ERF is a promising method to improve patient quality of life that is less invasive, controls inflammation, and facilitates subsequent definitive CRT. [ABSTRACT FROM AUTHOR]

Background Thoracoscopic esophagectomy (TE) was reported that increased morbidity in the National Clinical Data analysis in Japan and technical proficiency is required as the esophageal surgery team. The aim of this study is to assess the degree of surgical difficulty from operation time and to applicate for esophageal surgery team-building and the education of next-generation. Methods Consecutive initial 33 cases by the same operator was statistically examined concerning the correlation between chest operation time and the empirical effect of the time shortening, BMI, obstructive pulmonary disorders, Rib cage area, tumor progression, preoperative treatment as an indicator of the degree of surgical difficulty. Rib cage area measured in the preoperative CT Imaging. Results As the factors affecting the extension of operating time, the narrower upper rib cage area correlated with the prolonged operation time in the univariate (P  = 0.0279) and multivariate (P  = 0.0125) analysis. Empirical time reduction (P  = 0.0429) also was correlated with chest operation time. In addition, there was a significant correlation between chest operation time and blood loss (P  = 0.0007). Conclusion In the training of TE, operating surgeon or first assistant should start from the patient with broad upper rib cage area in chest CT. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background Esophagorespiratory fistulas including esophagopulmonary fistulas occur in 5–10% patients with esophageal cancer with invasion to adjacent organs. With an esophagorespiratory fistula, saliva and food flow into the respiratory tract through the fistula and severe pneumonia or lung abscess can develop. Alternatively, whether chemoradiotherapy can be performed for patients with esophagorespiratory fistulas affects the further outcomes of treatment in these patients. An esophageal cancer patient with an esophagopulmonary fistula who underwent separation surgery with drainage tube-less (DRESS) esophagostomy and whose inflammation from the esophagorespiratory fistula could be effectively controlled, which facilitated the prompt administration of definitive chemoradiotherapy, is reported. Methods Case report: A 79-year-old man visited a clinic with a month-long history of dysphagia. Esophageal cancer at the middle thoracic esophagus was detected, and invasion of the left main bronchus and lower lobe of the right lung was seen on contrast-enhanced computed tomography (CT). Three weeks later, urgent CT showed a lung abscess in the lower lobe of the right lung that continued into the adjacent esophageal cancer, infiltrative shadows in the peripheral lung field, and a pleural effusion. Due to the esophagopulmonary fistula, the patient underwent emergency surgery that consisted of esophageal separation surgery and double bilateral esophagostomy on the right and left supraclavicular region and enterostomy (drainage tube-less esophageal separation surgery). Results Antibiotic drug therapy for pneumonia and lung abscess achieved a favorable outcome. Definitive chemoradiotherapy for the esophageal cancer was started from postoperative day 25. Radiotherapy could not be completed because of sepsis due to aspiration pneumonia, though the aspiration pneumonia improved with intensive treatment. At six-month follow-up, the patient had achieved relapse-free survival and is currently symptom-free. Conclusion Separation surgery with a drainage tube-less (DRESS) esophagostomy is the less invasive operative procedure, which allows prompt initiation of chemoradiotherapy. In many cases of esophageal surgeries, an external esophagostomy is made with a drainage tube, and drainage tubes sometimes cause trouble and affect the quality of life of patients after surgery. However, our drainage tube-less (DRESS) esophagostomy might improve patient's quality of life. In addition, evaluation of esophageal cancer by endoscopic examination through the esophagocutaneostomy can be easily performed. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]