Three elderly patients with lower esophageal cancer successfully treated by transhiatal esophagectomy assisted by mediastinoscopy

Mediastinoscopy-assisted transhiatal esophagectomy recently has been applie d in patients with intrathoracic esophageal cancer. Elderly patients with e sophageal cancer experience several types of complications and often cannot undergo standard transthoracic esophagectomy. In this study, three elderly patients with preoperative complications underwent mediastinoscopy-assiste d transhiatal esophagectomy for esophageal cancer located in the lower part of the esophagus. Patient 1 was an 80-year-old man with alcoholic liver ci rrhosis. Patient 2 was a 78-year-old man with bronchial asthma. Patient 3 w as an 81-year-old-naan with diabetes mellitus and an atherosclerotic obstru ction of the lower extremities. In these patients, mediastinoscopy-assisted transhiatal esophagectomy concomitant with reconstruction by means of a ga stric tube was performed. Lymph node dissections of the middle and lower me diastinum and of the abdomen, including the regions surrounding the left ga stric and celiac arteries, were performed. Postoperative complications deve loped only in patient 1; minor leakage of the esophagogastrostomy and high bilirubinemia were observed. Metastasis was detected in the lymph nodes sur rounding the celiac artery in patient 1 and surrounding the left gastric ar tery in patients 2 and 3. Patient 2 died of pneumonia 18 months later, but the other patients have been well, without recurrence of the cancer after s urgery. In conclusion, mediastinoscopy-assisted transhiatal esophagectomy h as some benefits for elderly esophageal cancer patients who experience preo perative complications.