How does laparoscopic endorectal extraction treat esophageal cancer?

   So far, we have successfully performed esophageal cancer resection, laparoscopic esophageal inversion and extraction, and cervical segmental esophageal tubular gastric anastomosis for four patients with esophageal cancer.  The first patient, Lao Yang, had difficulty swallowing for most of the year. Four months before his consultation, he was found to have esophageal cancer, which was located in the upper chest and the root of the neck with extensive lesions. According to the traditional surgical method, he needed to undergo total laryngectomy + combined thoracoabdominal surgery to remove the tumor. Such a big operation made Lao Yang feel intimidated and could not make up his mind to treat it. Later, he heard that our thoracic surgery department has its special features in minimally invasive surgery for esophageal cancer, so he came to our hospital with the idea of giving it a try.  Considering that the patient’s tumor was large in size, located close to the larynx and infiltrated seriously with the surrounding tissues, experts decided to treat the patient with chemotherapy first to shrink the tumor, and then operate to preserve the larynx and its functions.  After 4 courses of chemotherapy, Lao Yang’s tumor really shrunk from the previous 6 cm to 3 cm, and from covering the esophagus for a week to only in the left and posterior wall of the esophagus, providing an obvious surgical clearance for the operation.  Before the operation, the president and general surgery expert Prof. Ji-Xiang Wu led the deputy director of head and neck surgery Xiaohong Chen, director of thoracic surgery Jianye Li, deputy chief physician Lei Yu and chief physician of oncology surgery Shurong Zhang to discuss Lao Yang’s surgical plan carefully and decided to perform the operation in two groups simultaneously. The laparoscopic group completed the freeing of stomach and tubular gastroplasty, esophageal inversion and extraction; the neck surgery group completed thyroid left lobe resection, esophageal tumor resection and cervical segment esophageal tubular gastric anastomosis.  Due to adequate preparation, although it was a complex surgery with multidisciplinary cooperation, it went very smoothly. President Wu first led the laparoscopic surgery team to make four “small holes” in the patient’s abdomen, each only 5-10 mm in diameter. The gastric and lower esophagus were freed using pneumoperitoneum and abdominal suspension without pneumoperitoneum laparoscopic techniques. Then, a small incision of 3 cm was made along the midline of the abdomen and an abdominal suspension hook was placed. The esophageal band was drawn to the neck using a gastric tube, and the broken end of the esophagus was sutured to the esophageal band and then ligated for reinforcement. The esophagus is gradually removed from the bottom to the top. The original esophageal bed was dilated and hemostatic by subsequent compression with a gauze pad. After removal of the gauze pad, the tubular stomach was retracted to the neck. Meanwhile, the neck surgery team led by Chen Xiaohong, deputy director of head and neck surgery, made an incision through the patient’s neck, removed the lesioned left lobe of the thyroid gland, freed the esophagus, cleared all groups of lymph nodes in the left neck, and cut the esophagus at 1 cm ventral to the entrance of the esophagus to remove the lesion. Finally, a high level anastomosis of the cervical esophagus to the tubular stomach was completed.  The operation took two and a half hours, and the patient only lost 240 ml of blood. On the second day after the operation, Lao Yang was able to get out of bed. Since the trauma was minimal, there was no severe pain, which facilitated his sputum removal and accelerated the recovery process even more. At present, Lao Yang has been discharged from the hospital. His wife said happily, “It was a big operation, and I heard it was very difficult! We didn’t expect him to recover so quickly, thanks to the experts at Beijing Tongren Hospital!” Yang was even more excited, “His life is saved! He can still talk!” Yang’s wish has come true!  It is understood that this surgery is the first of its kind in our hospital and the first of its kind in China. The biggest feature is that it concentrates the advantages of various disciplines, minimizes the surgical trauma to the patient, reduces the patient’s pain, greatly shortens the patient’s post-operative recovery time, achieves the effect of surgical cure, and improves the success rate of the surgery. This patient-centered and multidisciplinary medical model is also a trend in the development of modern medicine and a new weather of cooperation between basic and key disciplines in our hospital, which is another blessing for patients.