The Role of a Minimally Invasive Approach in Esophagectomy With Aortic Resection: Insights From Our Experience

Background At our institution, we have actively performed esophagectomy with aortic resection for locally advanced thoracic esophageal cancer with aortic invasion, as long as curative resection was deemed feasible. In recent years, the widespread adoption of minimally invasive techniques has led to most esophagectomies being performed thoracoscopically or with robotic assistance. Given this trend, we have adopted a minimally invasive approach for esophagectomy with aortic resection and have successfully performed cases using this technique. Here, we report our surgical approach and discuss its significance. Methods After general anesthesia induction, a sheath was placed in the femoral artery and vein via the inguinal region in the supine position. The patient was then positioned in the left semi-prone position for esophagectomy via a right thoracoscopic approach, excluding the aortic invasion site, followed by chest closure. Next, in the right lateral decubitus position, left thoracotomy was performed to establish extracorporeal circulation, resect the descending aorta, and place a graft. Finally, the patient was returned to the supine position for cervical lymphadenectomy, if necessary, and cervical esophagostomy creation. Results This surgical approach allowed both gastroenterological and cardiovascular surgeons to complete their respective procedures with a standard field of view and nearly identical techniques to conventional procedures. Previously, achieving both esophagectomy and aortic resection required either a bilateral thoracotomy or a median sternotomy with left thoracotomy to secure a left thoracic approach, or performing aortic resection with limited visibility via right thoracotomy. This new approach overcame these limitations, providing an optimal method for both specialties to operate effectively while maintaining a familiar surgical view and procedure. Conclusion In esophagectomy with concomitant aortic resection, a minimally invasive right thoracic approach was shown to reduce surgical invasiveness and overcome visibility constraints, suggesting its potential contribution to standardizing the procedure.