TP HCMThe surgeon performed three-stage laparoscopic surgery on the chest – abdomen – neck to completely eliminate malignant tumors and reconstruct the esophagus with a gastric tube for Mr. Thai, 74 years old.
Mr. Nguyen Thai went to Tam Anh General Hospital in Ho Chi Minh City for examination due to choking and hiccups for more than three months with unknown cause. The results of a computed tomography (CT) scan of his abdomen and chest showed abnormal thickening of the esophageal wall in the middle third (at the level of the T6-7 thoracic vertebrae), with no invasion of the aorta or trachea. and neighboring agencies.
On April 27, Dr. Do Minh Hung, Director of the Center for Gastrointestinal Endoscopy and Surgery, said that Mr. Thai had stage three esophageal cancer. The damage to his esophageal wall was 4 cm in size and had eaten into the muscle layer.
The patient has a large tumor, is older, and has underlying high blood pressure. Unskilled surgery has the risk of complications such as perforation causing massive bleeding, tearing of the vena cava, perforation of the bronchus, tearing of the pericardium, which is a challenge for the surgery.
Doctors decided to perform laparoscopic surgery through the abdomen and chest to completely remove the esophagus and remove lymph nodes in the neck – chest – abdomen area to prevent cancer cells from progressing. At the same time, the esophagus is created with a stomach tube inserted into the neck, connected to the esophagus, and the jejunum is opened to feed the patient in the early period after surgery.
Computed tomography (CT) scan showed the tumor located next to the aortic arch. Image: Tam Anh General Hospital
“The surgery is complicated because the esophagus is related to important organs in the body such as the heart, lungs, air-bronchi, arterio-vena cava and recurrent nervous system,” Dr. Hung said.
The team decided to operate in three stages, including chest – abdomen – neck. Starting from the chest phase, the laparoscopic surgery team enters the chest to dissect the esophagus to surrounding organs, cut across the esophagus at the level of the simple vein, and preserve the right bronchial artery; At the same time, curettage of the right and left paratracheobronchial lymph node groups, preserving the recurrent nerve; Subbronchial and paragastric lymph node dissection, preserving the thoracic duct.
After the chest surgery, the endoscopy team went into the abdomen to remove the lymph nodes, then cut the stomach to shape the esophagus, create a pylorus, and open the jejunum to help with feeding.
Neck surgery is the final step in the surgery. Doctors opened a horizontal line in the neck, dissected the lateral cervical lymph nodes, and preserved the recurrent nerve. Then, the surgical team brought the stomach tube up to the neck to connect with the esophagus, cut across the esophageal tube and stomach tube, and sewed up the connection. The surgery was completed in 8 hours.
Doctor Hung (middle) and his team performed surgery on Mr. Thai. Image: Tam Anh General Hospital
After two days of surgery, the patient was fully awake, the incision was dry, could walk on his own, and learned to drink by mouth after two days. He was expected to be discharged from the hospital 8 days later. The patient needs jejunal feeding support for an additional 10 days because the newly formed esophagus is not stable, limiting nutrient absorption.
Pathological results determined that Mr. Thai had squamous carcinoma that invaded the muscle layer (also known as squamous cell esophageal cancer), a metastatic lymph node. Oncologists will continue treatment after he stabilizes his health.
Dr. Minh Hung said that laparoscopic surgery through the chest and abdomen has many advantages such as small incisions and less trauma. Doctors perform operations in the mediastinum conveniently, the amount of blood loss is small, the rate of accidents and complications is reduced, the hospital stay is short, and the patient recovers quickly.
Esophageal cancer is often detected at a late stage due to unclear symptoms. When symptoms such as choking, weight loss, chest pain, etc. appear, the disease is usually in the late stages. The ability to completely treat esophageal cancer is low, only about 25% because the disease is often detected at a late stage, when the cancer has metastasized.
Dr. Minh Hung recommends that everyone should live scientifically, prevent risk factors, and have regular health check-ups to screen for cancer. Detecting cancer at an early stage when there are no symptoms, treatment effectiveness is better because it can be removed through flexible endoscopy.