Safety of Mediastinoscopic Esophagectomy for Highly Advanced Cancer Above Ct3br in Our Hospital

Abstract Background In recent years, conversion and salvage surgeries have increased due to the development of multidisciplinary treatment. On the other hand, these surgeries are more invasive than conventional esophageal cancer surgery due to chemotherapy and radiotherapy, and there are concerns about the increased risk of intraoperative and postoperative complications. In our hospital, mediastinoscopic esophageal subtotal resection has been performed for all esophageal cancers since April 2018, and is also indicated for conversion, salvage, and other highly advanced cancers. However, the safety of mediastinoscopic surgery for highly advanced cancers is still unknown. Methods We retrospectively investigated the short-term results of mediastinoscopic sub-total esophagectomy for esophageal cancer performed at our hospital, divided into two groups: cT3br or higher (group A) and cT3r or lower (group B), and evaluated their safety. A total of 153 patients with esophageal cancer who underwent mediastinoscopic subtotal esophagectomy from April 2018 to December 2024 were included. Results The median age of patients in group A was 71.5 years and cT3br/T4: 8/22. The median operative time was 554 minutes, and the median blood loss was 125 mL. 10% of the patients had Clavien-Dindo (CD) III or higher postoperative complications. Median postoperative hospital stay was 15 days. The median age of patients in group B was 75 years, and cT1/T2/T3r: 49/15/59. The median operative time was 480 minutes, and the median blood loss was 67.5 mL. 17.9% of patients had postoperative complications of CD III or higher. The median postoperative hospital stay was 12 days. Conclusion We considered that mediastinoscopic subtotal esophagectomy for esophageal cancer of cT3br or higher could be performed safely in our hospital.