370. TRANSMEDIASTINAL ESOPHAGECTOMY IS USEFUL FOR ESOPHAGOGASTRIC JUNCTION CANCER

Abstract Background The extent of surgical resection and lymph node dissection in esophagogastric junction cancer depends on the localization tumor center length esophageal invasion. We developed Robot assisted-transmediastinal esophagectomy (TME) have been applied for thoracic cancer. Since 2018, we also TME (EGJ) with involvement according to our determined indications, examined its safety usefulness. Methods Our indication esophagetomy EGJ is, i) squamous cell carcinoma, ii) differentiated adenocarcinoma with≧3 cm involvement, iii) poorly with≧2 cm. all these cases. operation procedure is following; upper paraesophageal LNs recurrent nerve are dissected by left-side cervical mediastinoscopic approach. Lower mediastinal LN laparoscopic Subcarinal main bronchus transhiatal robotic When robot not used, mediastionscopically. Reconstruction done gastric tube through posterior route. Results Between January 2018 March 2023, 36 patients was performed In these, used 24 patients. Median time amount blood loss were 429 minutes 170 mL. Pathological metastasis paratracheal LNs; right LNs, left tracheobronchial detected 2(5.5%), 1(2.7%) patients, respectively. Anastomotic leakage occurred 2(5.5%) but recovered conservatively. Recurrent laryngeal (RLN) palsy severe more than Clavien-Dindo (CD) grade III occurred. Postoperative complications≧C-D IIIb patient. Conclusion seems be safe, especially can avoid intra-mediastinal anastomosis complication associated leakage. It might widely accepted when RLN could reduced. Recuurent cause palsy, recommended algorism because frequency low, so without option