Short-Term Results of Mediastinoscopic Subtotal Esophagectomy for All Cases of Esophageal Cancer

Abstract Background Recently, mediastinoscopic surgery for esophageal cancer has become popular. Mediastinal surgery does not require chest wall destruction or one-lung ventilation, and is considered to have fewer respiratory complications, making it suitable for elderly patients and patients with respiratory disease. However, there is still no consensus on how far to expand the indications for mediastinoscopic surgery. Although mediastinoscopic subtotal esophagectomy has been the first choice for all esophageal cancer patients at our hospital since April 2018, the safety of this procedure in all patients with esophageal cancer, including advanced cancer, is not yet clear. Methods we investigated the short-term postoperative outcomes of radical esophagectomy for esophageal cancer performed at our hospital from April 2018 to November 2024, and examined the safety of this procedure. Results The results showed that mediastinoscopic sub-total esophagectomy was completed in 144 patients with esophageal cancer. The median age was 73.5 (66–79) years, cT1/2/3r/3br/4: 45/14/56/7/22. cStage0/I/II/IIIAB/IVAB: 10/26/29/57/22. Preoperative treatment FP/DCF/CRT: 13/79/5 cases. The operation time was 523 (448–581) minutes, blood loss was 100 (55–180) ml, and postoperative complications were CD-III or higher in 14.6% (21/144) of the patients. All complications above CD-I included suture failure 6.3% (9/144), pneumonia 16.0% (23/144), recurrent nerve palsy 30.6% (44/144), SSI 4.9% (7/144). Postoperative hospital stay was 14 (12–19) days, open chest conversion rate was 0.7% (1/144), and R0 resection rate was 94.4% (136/144). Conclusion These results suggest that the postoperative complication rate and hospital stay are acceptable, and that mediastinoscopic esophageal subtotal resection can be safely performed in all patients with esophageal cancer, including conversion and salvage cases. We will discuss the details of surgical techniques and precautions in performing mediastinoscopic sub-total esophageal resection in all cases of esophageal cancer.