Index. Azygous vein division of, thoracoscopic division of, 150

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1 A Adenocarcinoma of esophagus acute and chronic inflammation, 6 7 gastroesophageal reflux disease, 5 6 genetic factors, 4 5 Helicobacter pylori infection, 6 incidence, 4 obesity, 6 gastric cancer, low- and high-risk factors, 12 in United States, 137 Adjuvant chemotherapy, gastric cancer, Adjuvant therapy with overall survival, 75 postgastrectomy survival, 85 Advanced gastric cancer definition, 63 macroscopic appearance, 63, 65 spreading and prognosis, staging of, AF. See Atrial fibrillation (AF) Aging esophageal cancer, 54 gastric cancer, 61 Alcohol consumption, 3, 4, 6 Alcohol dehydrogenase mutation, 3 American College of Gastroenterology, American Society for Gastrointestinal Endoscopy (ASGE), 21 American Society of Anesthesiologists, 36 Amiodarone, 53 Anastomotic leakage, 43, 161 Arrhythmia cardiac, 43 esophageal cancer surgery, 53 perioperative complications, 191 risks of, 53 ARTIST trial study, 110, 111 ASCC1 signaling, esophageal cancer, 4 ASGE. See American Society for Gastrointestinal Endoscopy (ASGE) Atrial fibrillation (AF) cardiac arrhythmias, 43 postoperative risk, 53 Azygous vein division of, thoracoscopic division of, 150 B Balloon-mounted esophagoscope, Barrett s esophagus (BE), 5 6, 11, 17, Barrx Ablation System, 14, 15 Billroth I anastomosis extracorporeal, intracorporeal common entry hole closure, duodenum opening, duodenum transection, 215, 217 linear stapler insertion, 218 liver retraction, 215 published reports, 215, 216 specimen delivery, 217 stomach opening, 217, 218 stomach transection, 217 Billroth II (BII) loop gastrojejunostomy, 230 British Stomach Cancer Group, 109 C CALGB study, 109, 111 Cap resection technique, EMR, 16 Cardiac arrhythmias, 43 Cell-sheet technology, 22 Cervical anastomosis creation of, 127 laparoscopic/thoracoscopic transhiatal esophagectomy abdominal dissection, advantages, 155 anesthetic/induction phase, cervical dissection, disadvantages, 155 patient positioning, 148 postoperative care, preoperative preparation, 147 reconstruction, thoracoscopic dissection, respiratory complications, 42 S.N. Hochwald, M. Kukar (eds.), Minimally Invasive Foregut Surgery for Malignancy: Principles and Practice, DOI / , Springer International Publishing Switzerland

2 270 Chemotherapy gastric cancer adjuvant chemotherapy, perioperative neoadjuvant chemotherapy, perioperative, with radiation, 85 salvage, 115 single-agent, 112 Chylothorax, 43 Cigarette smoking, 2 Circumferential resection margin (CRM), Clinical pathways, for esophagectomy, College of American Pathologists (CAP), 38 Colonic interposition, Computed tomography (CT) and external US, 37 and PET-CT, 137 transmural tumors, 200 CRM. See Circumferential resection margin (CRM) Cryotherapy, CTHRC1 signaling, esophageal cancer, 4 5 D Definitive chemoradiotherapy (dcrt), D2 lymphadenectomy advantages, 231 clinical studies, laparoscopic subtotal gastrectomy with ( see Laparoscopic subtotal gastrectomy) Double tract anastomosis, See also Proximal gastrectomy Dysplasia gastric cancer, HGD, 11 esophageal cancer, low- and high-risk factors, 12 low-grade vs. high-grade, E Early gastric cancer (EGC) definition, 63 endoscopic resection, 64 with gastric ulcer, identification and diagnosis, 93 laparoscopic distal gastrectomy, Paris classification, proximal gastrectomy, spreading and prognosis, 67 undifferentiated intramucosal, 102 ECHELON FLEX Powered ENDOPATH Stapler, ECM. See Extracellular matrix (ECM) EEA anastomosis, MIE anesthetic management, 128 endoscopic evaluation, 128 laparoscopic phase, McKeown esophagectomy, 128 outcomes, postoperative care, 135 techniques, 128 thoracoscopic phase, EGC. See Early gastric cancer (EGC) ELND. See Extended LN dissection (ELND) EMR. See Endoscopic mucosal resection (EMR) Endoscope enteral access, 185 for ESD, 97 gastroesophageal junction, Endoscopic ablation therapy cryotherapy, purpose of, 14 radiofrequency ablation, 14, 15 Endoscopic mucosal resection (EMR) cap resection technique, 16, 93 vs. ESD, 20 esophageal malignancy, 15 gastric cancer, 76, 93 ligate-and-cut technique, 16 retrospective study, 17 for staging purposes, 13, 14 techniques, types of, 16 Endoscopic resection (ER) complication associated with, 15 early gastric cancer with gastric ulcer, well-differentiated, 64 EMR, ESD, gastric cancer indication, therapeutic efficacy, 94 goals of, 15 indication for, oncology nurse coordinator, 27 risk factors, 17 SCC, 13 therapeutic efficacy of, 94 Endoscopic submucosal dissection (ESD) complications, 20 early gastric cancer, 64 vs. EMR, 20 esophageal squamous cell carcinoma, 19 gastric cancer, 76 distal attachment, endoscope, 97 high-frequency generator, 98 high-frequency knives, 95 indication, IT-knife type, needle type knives, 95 non-it-knife type, 97 procedure, scissors forceps type, 97 severe fibrosis with ulcer, therapeutic efficacy, 94 undifferentiated adenocarcinoma,

3 injection solutions for, 17 needle knives for, 17, 20 schematic representation, 18 Endoscopic ultrasound (EUS) esophageal cancer, 36 esophageal-preserving therapy, EUS-guided fine-needle aspiration, 137, 177 transmural tumors, 200 Epidermal growth factor (EGF), 5 Epstein Barr virus (EBV) infection, 62 ESD. See Endoscopic submucosal dissection (ESD) Esophageal benign tumors laparoscopic enucleation anti-reflux mechanism, 180 surgical indications, surgical procedures, thoracoscopic enucleation balloon-mounted esophagoscope, esophageal myotomy, 178 indications, procedures, Esophageal cancer adenocarcinoma gastroesophageal reflux disease, 5 6 gender influence, 5 genetic factors, 4 5 Helicobacter pylori infection, 6 incidence, 4 obesity, 6 evaluation of surgery, 51 HGD, at high-volume institutions, 26 incidence, 1 laparoscopic transhiatal esophagectomy, 119 abdominal dissection, cervical component, complications, contraindications, 120 Kocher maneuver, 121 outcomes, patient positioning, 120 port placement for, 121 short-term results for, 124 medical evaluation, age-related comorbidities, 54 cardiac, 53 hepatic disease, obesity, pulmonary complications, 53 venous thromboembolism, 55 neoadjuvant chemoradiotherapy, 27 noninvasive staging modalities, 137 nutritional assessment, operative resection, 35 optimization, prior surgical history, 55 resection long-term survival after, 44 volume-outcome relationship, risk factors, 1 SEER analysis, 40 squamous cell carcinoma, 1 alcohol consumption, 3 alcohol dehydrogenase mutation, 3 caustic injury, 4 poverty, 4 raw fruit vs. vegetable consumption, 4 tobacco use, 2 3 surgical therapy for dcrt, lymphadenectomy, morbidity, mortality/quality control, multidisciplinary approach, 35 operative resection, 35 patient selection, 36 performance indicators, 45 resection margins, tumor selection, T1a/T1b cancer, in United States, 137 Esophageal-preserving therapy advances in, 22 approaches, 11 clinical staging, HGD, long-term outcome, management after, 21 patient selection, T1a/T1b esophageal cancer, 13 transnasal endoscopy, 21 Esophageal resection clinical pathways associated with, long-term survival after, 44 minimally invasive techniques for, 123 volume-outcome relationship, Esophageal squamous cell cancer endoscopic submucosal dissection, 19 risk factors for, Esophageal stent advantages/disadvantages, 56, 57 obstructive symptoms, 28 placement (see also Minimally invasive feeding tube) complications, 184 evaluation, outcomes, 185 steps for, Esophagectomy, 11, 13. See also Specific types clinical pathways for, esophageal cancer (see Esophageal cancer) hospital volume and, 25 laparoscopic/thoracoscopic abdominal dissection, operative description, 138 thoracic anastomosis, thoracic dissection, minimally invasive vs. open, respiratory failure, Esophagotomy, 142, 154

4 272 European Organization for Research and Treatment of Cancer (EORTC), , 111 EUS. See Endoscopic ultrasound (EUS) Extended LN dissection (ELND), 80, 87 External US, esophageal cancer, 37 Extracellular matrix (ECM), 5, 14, 22 G Gastrectomy. See also Specific types gastric cancer failure pattern, 85 survival outcomes, 86 HDGC, 69 open standards, 76, 77 palliative-intent, 85 prophylactic, 87 reconstruction options, 83 robotic surgery systems, Gastric Adenocarcinoma and Proximal Polyposis of the Stomach (GAPPS), 61, 68, 69, 87 Gastric cancer (GC) adenocarcinoma, advanced (see Advanced gastric cancer) age-standardized, 61 bevacizumab in, 113 CALGB study, 109 classification, 65, 66 dysplasia, EGC (see Early gastric cancer (EGC)) endoscopic submucosal dissection distal attachment, endoscope, 97 high-frequency generator, 98 high-frequency knives, 95 indication, IT-knife type, needle type knives, 95 non-it-knife type, 97 procedure, scissors forceps type, 97 severe fibrosis with ulcer, therapeutic efficacy, 94 undifferentiated adenocarcinoma, epidemiology, 61 etiology of, gastrectomy failure pattern, 85 prophylactic, 87 survival outcomes, 86 Helicobacter pylori infection, hereditary syndromes GAPPS, 69 HDGC, histological subtypes of, 66 Kaplan-Meier curve, 107 macroscopic appearances, 63 metastatic (see Metastatic gastric cancer) microscopic appearances, minimally invasive intragastric surgery, molecular pathology, multimodality therapy adjuvant chemotherapy, incidence, 105 perioperative neoadjuvant chemotherapy, postoperative chemoradiation, 111 radiation role, noncurative operative procedure, operative therapy historic development, 74 intra- and postoperative considerations, lymph node dissection, multidisciplinary strategy, preoperative intents, reconstruction technical aspects, 82 technical aspects of resection, perioperative chemotherapy trials, 106 REAL-2 study, 113 risk factors, robot-assisted gastrectomy ( see Robot-assisted gastrectomy (RG)) surgical objectives, 73 TAX325 trial study, TNM classification, 67 WHO classifications, 62, 65 Gastric conduit anatomy, 130 aspects, 142 creation, , 154 distal portion, 132 gastrotomy, 143 Gastrocolic omentum, 121, 129, 139 Gastroduodenostomy. See Billroth I anastomosis Gastroesophageal anastomosis, Gastroesophageal reflux disease (GERD), 5 6, 21, 55 Gastrointestinal stromal tumors (GISTs) diagnosis, 206 esophageal, 178 GIST Consensus Conference, 205 laparoscopic partial gastrectomy ( see Laparoscopic partial gastrectomy) special considerations, 87 symptoms, 206 therapeutic strategy, 206 Gastrojejunostomy, 240 BII loop gastrojejunostomy, 230 laparoscopic subtotal gastrectomy clinical studies, meta-analyses, 224 patient position, patient selection, 226 procedure, randomized trials, 224 reconstruction, robotic gastrectomy, room setup, Western distal gastrectomy studies, Roux-en-Y gastrojejunostomy, 213 Gastroscopy, 202, 229

5 Gastrostomy advantages/disadvantages, 56 anterior, anvil insertion through, 255 closure, 202 gastric conduit, 143 laparoscopic complications, 57, 187 use of, 56 GC. See Gastric cancer (GC) Gender influence, esophagus, 5 Genome-wide association studies, GISTs. See Gastrointestinal stromal tumors (GISTs) Granulocyte colony-stimulating factor (GCSF), 113 H HDGC. See Hereditary diffuse gastric cancer (HDGC) Helicobacter pylori infection esophageal adenocarcinoma, 6 gastric cancer, Hepatic disease, Hereditary diffuse gastric cancer (HDGC), 61, Hereditary syndromes, of gastric cancer GAPPS, 69 HDGC, High-frequency generator (HFG), for ESD, 98 High-grade dysplasia (HGD) esophageal cancer, low- and high-risk factors, 12 prospective study, 14 and T1a cancer, 11 12, 20, 21 Human epidermal growth factor receptor 2 (HER2) inhibitor, I Interleukin-18, 5 Intraepithelial neoplasia (IEN), IT-knife type, ESD, J Jejunostomy advantages/disadvantages, feeding jejunostomy tube placement, 130 outcomes for laparoscopic, 187 percutaneous endoscopic jejunostomy, 185 K Kaplan-Meier curve, 107 Knives for ESD, 95, 97 Kocher maneuver, 121, 130, 139, 215 L Laparoscopic distal gastrectomy (LDG) contraindication, 214 extracorporeal Billroth I reconstruction, incision and exposure, indications, intracorporeal Billroth I anastomosis common entry hole closure, duodenum opening, duodenum transection, 215, 217 linear stapler insertion, 218 liver retraction, 215 published reports, 215, 216 specimen delivery, 217 stomach opening, 217, 218 stomach transection, 217 preoperative preparation, 214 Laparoscopic enucleation, esophageal benign tumors anti-reflux mechanism, 180 indications, procedures, Laparoscopic intragastric surgery (LIGS) advantages, 200 indications, preoperative diagnosis, 200 procedure, resection, surgical planning, 200 Laparoscopic jejunostomy tube placement complications, 187 extracorporeal technique, 186 illustration, 186 outcomes, 187 placement steps, 185, 186 port sites, 185, 186 Laparoscopic partial gastrectomy anatomic classification, gastric lesions, 205, 206 antrum/prepyloric region, fundus and greater curve, lesser curve/gastroesophageal junction, outcomes, 211 postoperative care, 211 preoperative planning, therapeutic strategy, 206 Laparoscopic subtotal gastrectomy clinical studies, meta-analyses, 224 patient position, procedure, randomized trials, 224 reconstruction, robotic gastrectomy, room setup, Western distal gastrectomy studies, Laparoscopic/thoracoscopic esophagectomy abdominal dissection, colonic interposition abdominal phase, morbidity/mortality, 162 patient selection/evaluation, 158 postoperative care, thoracic phase, 160 operative description, 138 thoracic anastomosis, thoracic dissection,

6 274 Laparoscopic transhiatal esophagectomy cervical anastomosis abdominal dissection, advantages, 155 anesthetic/induction phase, cervical dissection, disadvantages, 155 patient positioning, 148 postoperative care, preoperative preparation, 147 reconstruction, thoracoscopic dissection, esophageal cancer, 119 abdominal dissection, cervical component, complications, contraindications, 120 Kocher maneuver, 121 outcomes, patient positioning, 120 port placement for, 121 short-term results for, 124 Laparoscopy plastic, 123 vs. robotic gastrectomy, staging in gastric cancer, 76 intraoperative, 37 Laparoscopy-assisted total gastrectomy abdominal esophagus, 254 dissection abdominal esophagus, 254 anvil insertion, drain insertion, 260 duodenal transection, 250, 251 extracorporeal jejunojejunostomy, 258 gastrocolic ligament, 246, 248 gastrosplenic ligament, jejunum, laparoscopic esophagojejunostomy, left gastroepiploic vessels, 248 lesser omentum, 251 lymph nodes, pancreas, proximal stomach, 249 right gastric artery, 251, 252 stapled duodenal stump, 250 liver retraction, patient position, 243, 244 port placement, 243, 245 Laurén s classification, gastric cancer, 65 Leapfrog Group, 26 Ligate-and-cut technique, EMR, 16 Lymphadenectomy dissection, 139 D2 lymphadenectomy (see D2 lymphadenectomy) esophageal cancer, intraoperative images, 81 survival benefit, 41 three-field (see Three-field lymphadenectomy) two-field, Lymph node dissection (LND), 228, 267 gastric artery, gastric cancer, gastroepiploic artery, hepatic artery, resection extent/fields, 40 splenic artery, 239 M Malnutrition, factors associated with, 56 Medical Research Council (MRC), 107 Metastatic gastric cancer first-line treatment of, management, salvage therapy, targeted therapies, MicroRNA, gastric cancer, 69 Minimally invasive esophagectomy (MIE) anesthetic management, 128 approaches, 120 in Barrett s disease, 120 description, endoscopic evaluation, 128 esophageal cancer, laparoscopic phase feeding jejunostomy tube placement, 130 gastric mobilization, gastric tube creation, 130 patient positioning, port placement, pyloroplasty, 130 McKeown esophagectomy, 128 obesity, 55 vs. open esophagectomy, operative resection, 35 outcomes, postoperative care, 135 prior surgical history, 55 pulmonary complications, 53 thoracoscopic phase dissection, drain placement and closure, 134 gastroesophageal anastomosis, patient positioning, 131 port placement, 131, 132 preparation for, Minimally invasive feeding tube evaluation, extracorporeal technique, 186 laparoscopic jejunostomy tube complications, 187 extracorporeal technique, 186 illustration, 186 outcomes, 187 placement steps, 185, 186 port sites, 185, 186 outcomes, 184, 185 percutaneous endoscopic jejunostomy, 185

7 275 steps for, Minimally invasive surgery (MIS), 73, 76 MSR1 signaling, 4 N Nakamura s classification, gastric cancer, 65 Needle knives, for ESD, 17, 20, 95 Neoadjuvant chemoradiotherapy dcrt and, esophageal cancer, 27 Non-IT-knife type, ESD, 97 Nutritional assessment, esophageal cancer, 28, O Obesity, esophageal cancer, 6, Open esophagectomy MIE vs., 30 31, 124 postoperative morbidity, 162 Operative therapy, of gastric cancer general objectives, 73 historic development, 74 intra- and postoperative considerations, lymph node dissection, multidisciplinary strategy, preoperative intents, reconstruction technical aspects, 82 technical aspects of resection, P Penrose drain (PD) diaphragm level, 193 distal esophagus, 159, 160 GE junction, liver retraction, 245 Percutaneous endoscopic jejunostomy (PEJ), 185 Percutaneous radiologic gastrostomy (PRG), 56 Perioperative neoadjuvant chemotherapy, Positron emission tomography (PET) esophageal cancer, 36, 37 gastric cancer, 76 PRG. See Percutaneous radiologic gastrostomy (PRG) Prone position. See Thoracolaparoscopic esophagectomy Proximal gastrectomy, 77 dissection abdominal esophagus, hepatic artery, left gastrocolic ligament, 236 left gastroepiploic artery, lesser curvature, 238 short gastric artery, splenic artery, 239 stomach, 239 drain insertion, 241 indication, 235 outcomes, 241 reconstruction, trocar insertion, Pulmonary complications, esophageal cancer, 53 Pyloromyotomy, 77, 123, 130, 170 Pyloroplasty, 77, 130, 131, 170 R Radiation, gastric cancer, Radiofrequency ablation (RFA), 14 15, 17, 22 Reactive oxygen species, 3, 6 REAL-2 study, gastric cancer, 113 Recurrent laryngeal nerve injury, 43 Respiratory failure, esophagectomy, Rethoracoscopy, 173 RFA. See Radiofrequency ablation (RFA) Robot-assisted gastrectomy (RG) advantages, 261 cost, 267 vs. laparoscopy, learning curve, 265 oncologic outcomes, patient position, 262 patient selection, 265 perioperative outcomes, port placement, 262 procedure, Robot-assisted thoracoscopic esophagectomy (RAMIE) disadvantages, 195 indications, laparoscopic dissection, perioperative management complications, 191 fluid, 191 intraoperative, 190 one-lung ventilation, postoperative care, 191 preoperative, 190 postoperative care, 195 results, thoracoscopic dissection patient position, procedure, robotic instruments, 191 Roux-en-Y gastrojejunostomy, 213, 230 Royal College of Pathologists (RCP), 38 RTOG 0114 randomized phase II study, 109, 111 S Salvage therapy chemotherapy, 115 metastatic gastric cancer, Scissors forceps type, ESD, 97 Sentinel node (SN) sampling, 37 Signet ring cell carcinoma, 102 Smoking esophageal cancer, 2 gastric cancer, 62

8 276 Squamous cell carcinoma of esophagus, 1 alcohol consumption, 3 alcohol dehydrogenase mutation, 3 caustic injury, 4 pathogenesis, 2 poverty, 4 raw fruit vs. vegetable consumption, 4 tobacco use, 2 3 in United States, 137 Surgical therapy for esophageal cancer dcrt, lymphadenectomy, morbidity, mortality/quality control, multidisciplinary approach, 35 operative resection, 35 patient selection, 36 performance indicators, 45 resection margins, tumor selection, gastric cancer historic development, 74 intra- and postoperative considerations, lymph node dissection, multidisciplinary strategy, preoperative intents, reconstruction technical aspects, 82 technical aspects of resection, T Targeted therapies, metastatic gastric cancer, T1a/T1b esophageal cancer, TAX325 trial study, gastric cancer, Thoracic anastomosis, laparoscopic/thoracoscopic esophagectomy, Thoracic epidural analgesia (TEA), 190 Thoracolaparoscopic esophagectomy advantages, postoperative care, results, rethoracoscopy, 173 three-field lymphadenectomy abdominal/laparoscopic phase, cervical phase, gastric tube formation, 170 pyloromyotomy, 170 thoracoscopic phase, two-hole esophagogastrectomy, 171 Thoracoscopic enucleation approach, esophageal benign tumors balloon-mounted esophagoscope, esophageal myotomy, 178 procedures, surgical indications, for esophageal leiomyoma, 179 Thoracoscopic transhiatal esophagectomy abdominal dissection, advantages, 155 anesthetic/induction phase, cervical dissection, disadvantages, 155 patient positioning, 148 postoperative care, preoperative preparation, 147 reconstruction, thoracoscopic dissection, Three-field lymphadenectomy abdominal/laparoscopic phase, cervical phase, gastric tube formation, 170 pyloromyotomy, 170 thoracoscopic phase, TNM classification of gastric cancer, 67 Tobacco use, of esophagus, 2 Transnasal endoscopy, 21 Two-fi eld lymphadenectomy, U Upper endoscopy antrum/prepyloric region, 209 conscious sedation, 21 initial/repeat, 51 intraoperative, 158 laparoscopic intragastric surgery, preoperative workup, 200 V Venous thromboembolism (VTE), 55 Volume-outcome relationship, esophageal resection, W Wedge gastrectomy. See Laparoscopic partial gastrectomy Will Rogers phenomenon, 41 Worldwide Esophageal Cancer Collaboration (WECC), 41

1. Epidemiology of Esophageal Cancer 2. Operative Strategies 3. Minimally Invasive Esophagectomy 4. Video

1. Epidemiology of Esophageal Cancer 2. Operative Strategies 3. Minimally Invasive Esophagectomy 4. Video Minimally Invasive Esophagectomy Guilherme M Campos, MD, FACS Assistant Professor of Surgery Director G.I. Motility Center Director Bariatric Surgery Program University of California San Francisco ESOPHAGEAL