A left thoracic approach in a prone position for thoracoscopic thoracic duct ligation in a patient with post-esophagectomy chylothorax: A case report

INTRODUCTION: We debate whether or not to approach from right thorax for the left chylothorax afteresophagectomy.PRESENTATION OF CASE: A 50 s-year-old female underwent right-sided thoracoscopic esophagectomywith three-field lymphadenectomy for esophageal carcinoma (type 0-IIa, 3.4 × 2.2 cm, T1bN0M0, StageIA), followed by reconstruction with esophagogastric anastomosis through the posterior mediastinum.The thoracic duct was excised and ligated. The left thoracic drainage increased to 2115 mL/day on thefifth postoperative day. Thoracic duct injury was diagnosed, and surgery was performed on sixth post-operative day. With the patient in a prone position, the thoracic duct was ligated successfully underthoracoscopy in the left thorax. The leakage point was found in the crushed duct by 8.8-mm tita-nium clips. Then, we performed mass ligation of the thoracic duct with 11-mm titanium clips belowthe leakage point after careful dissection. The surgery took 58 min, with an estimated total blood lossof 0 g.DISCUSSION: Although thoracic duct is anatomically located on the right side of the descending aorta,we employed a left-sided thoracoscopic approach due to the chylous leakage in the left thorax. With thepatient in the prone position, surgeons can easily convert from a left thoracic approach to a right thoracicapproach immediately without postural change if the thoracic duct cannot be found in the left thoraciccavity.CONCLUSION: This technique is useful and should be considered for patients with left chylothorax

Two Cases of Simultaneous Laparoscopic Surgery for Synchronous Gastric and Colon Tumors

Here we report two cases of the simultaneous laparoscopic surgery. Case 1 was a 63-year-old male who was referred to our hospital for the treatment of co-existing gastric cancer (T1aN0M0) and colon cancer (T1N0M0). We simultaneously performed laparoscopic sigmoidectomy and distal gastrectomy. It took 525 minutes and blood loss was 200 ml. Case 2 was a 77-year-old female who was referred to our hospital for the treatment of a low-risk gastrointestinal stromal tumor of the stomach co-existing with colon cancer (T2N0M0). We simultaneously performed laparoscopic ileocecal resection and partial resection of the stomach. The gastric tumor was treated by laparoscopic and endoscopic cooperative surgery. It took 451 minutes and the total blood loss was 100 ml. Each patient was discharged on postoperative day 13 without any complications. We believe that simultaneous laparoscopic surgery for synchronous malignant tumors under the guidance of an experienced surgeon is feasible and minimizes postoperative distress

EFFECT OF MODEST PERIOPERATIVE INTAKE OF IMMUNO-NUTRITION RICH IN ω -3 POLYUNSATURATED FATTY ACIDS ON IL-10 IN ESOPHAGEAL CANCER PATIENTS

Background Recent trials have shown that perioperative administration of an immuno-enhancing diet can reduce the incidence of infectious complications and shorten hospital stay following elective surgery. The purpose of this study was to evaluate whether a relatively small perioperative intake of ω -3 polyunsaturated fatty acid (PUFA)-rich nutritional supplement modulates postoperative inflammatory responses.Methods Twenty-three patients with esophageal cancer were prospectively randomized into Treatment (n=11) and Control (n=12) groups. The former drank 2 packs (0.4 L) of a liquid diet that was supplemented with ω -3 fatty acids each day for 6 consecutive days prior to esophagectomy, while the latter drank a control liquid. In addition, both groups received postoperative enteral feeding with the same formula. The levels of human leukocyte antigen-DR (HLA-DR), interleukin (IL)-6 and IL-10 were measured, and polymorphonuclear cell and total lymphocyte counts were obtained.Results Plasma IL-10 levels were significantly (p<0.05) higher in the Treatment group than the Control group after beginning supplemental nutrition. By contrast, postoperative IL-6 levels tended to lower in the Treatment group, but the difference did not reach the level of significance.Conclusions Preoperative oral intake of a small amount of ω -3 PUFA-rich nutritional supplement increased postoperative IL-10 expression