Minimally Invasive Revision Surgery for Thoracic Stomach Syndrome After the McKeown Esophagectomy; A Case Report

Background Thoracic stomach syndrome (TSS) after the McKeown esophagectomy with subtotal gastric conduit reconstruction is a rare complication. The main symptom of this condition is chest discomfort, especially after eating, which caused by a dilated stomach compressing the lung and mediastinum. Revision surgery can be considered in severe cases. There are some reports that a thoracotomy combined with laparotomy is critical for a successful revision and minimally invasive approach was limited success. Herein, we report the case of TSS successfully treated with minimally invasive surgery. Methods: Case presentation A 68-year-old male underwent minimally invasive McKeown esophagectomy for early-stage esophageal cancer, with subtotal gastric conduit and cervical anastomosis via a posterior mediastinal route. Postoperative pathology revealed pT1b, pN0. Three months post-surgery, anastomotic stricture was noted, treated with several endoscopic dilations, and the patient remained recurrence-free for 5 years. At 6 years postoperatively, he was hospitalized for aspiration pneumonia. CT showed gastric conduit dilation, but esophagram revealed no obstruction. Aspiration repeated many times after that. Therefore minimally invasive revision surgery was performed. Results Surgical procedure: The conduit was throacoscopically narrowed to a 4 cm width using linear stapler. The redundant conduit was retracted into the abdominal cavity and straightened laparoscopically. The gastric conduit was tacked to the bilateral crus and the hiatus around the conduit was closed. Aspiration improved post-surgery, and the patient was discharged on postoperative day 14 without any Clavien-dindo grade II or higher complications. Following surgery, the patient on longer experienced aspiration pneumonia. He was able to resume oral intake and had gained 6 kg in body weight 6 months after surgery. Conclusion We experienced a patient with TSS after the McKeown esophagectomy and successfully treated with minimally invasive revision surgery.