586. CIRCUMFERENTIAL HIATAL DISSECTION DURING MINIMALLY INVASIVE ESOPHAGECTOMY CLINICAL AND ONCOLOGICAL OUTCOMES

• Published in: Diseases of the esophagus 2022-09, Vol.35 (Supplement_2)
• Main Authors: Davakis, Spyridon, Sdralis, Ilias, Sakellariou, Stratigoula, Ziogas, Dimitrios, Theochari, Maria, Stratigopoulou, Panagiota, Ntoka, Polyxeni, Liakakos, Theodoros, Charalabopoulos, Alexandros
• Format: Article
• Language: English
• ISSN: 1120-8694; 1442-2050
• DOI: 10.1093/dote/doac051.586

Circumferential resection margin involvement is an independent prognostic factor in patients with adenocarcinoma of the distal esophagus and esophago-gastric junction. However, there is currently no consensus on the extent and the technique of hiatal dissection. Herein, we aim to present our technique of circumferential hiatal dissection during 2-stage totally minimally invasive esophagectomy for adenocarcinoma of the distal esophagus and esophago-gastric junction with its related histopathological results. A prospective study of 200 consecutive patients undergoing 2-stage totally minimally invasive esophagectomy over a period of 60 months was conducted. Dissection of the hiatus included peri-esophageal surrounding tissues in a cylindrical fashion maximizing the distance from the esophageal wall. Crural muscle fibers and pleura bilaterally, pericardial fat anteriorly and pre-aortic tissue posteriorly were excised en bloc. Histopathological results particularly focused on involvement of the circumferential resection margin. Complete histological clearance (R0) was achieved in 96% (n=192) according to the criteria of the College of American Pathologists and in 95% (n=190) according to those of the Royal College of Pathologists. In pT3 tumors (n=102), the circumferential resection margin was negative in 97 patients (95%) according to the College of American Pathologists, and in 95 (93%) according to the Royal College of Pathologists. Adoption of this safe and reproducible technique might reduce the incidence of circumferential resection margin involvement and improve pathological outcomes. In addition, there may be positive implications for training and quality control.