Cardiothoracic Surgery |

Concurrent Robotic-Assisted Pulmonary Lobectomy and Robotic-Assisted Ivor-Lewis Esophagectomy for Synchronous Primary Lung and Esophageal Cancers: A Case Report FREE TO VIEW

Eric Toloza, MD; Lindsey Bendure, MD; Christian Sobky, BS; Joseph Garrett, ARNP-C; Nasreen Vohra, MD; Dale Han, MD; David Kim, MD; Kenneth Meredith, MD
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Moffitt Cancer Center, Tampa, FL

Chest. 2014;145(3_MeetingAbstracts):38A. doi:10.1378/chest.1836732
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SESSION TITLE: Surgery Case Report Posters II

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Surgical resection is gold standard for early stage lung cancer and early stage esophageal cancer.

CASE PRESENTATION: A 72-year-old man was diagnosed with synchronous TTF1-positive right lower lobe (RLL) adenocarcinoma and TTF1-negative T3N1 gastroesophageal adenocarcinoma. After neoadjuvant chemoradiation for esophageal cancer, he consented to concurrent robotic-assisted Ivor-Lewis esophagectomy and robotic-assisted RLLobectomy. Gastric mobilization, celiac and paraaortic lymphadenectomy, pyloric botulinum injection, and feeding jejunostomy were performed via hand-assisted laparoscopy in supine position. Robotic-assisted video-thoracoscopic RLLobectomy, with mediastinal lymph node dissection (MSLND), was then performed in left lateral decubitus with 3 thoracoscopy ports, including a 4-cm camera port along the 6th intercostal space (ICS) at the anterior axillary line, which doubled as the assistant’s access port, and two 1-cm instrument ports along the 3rd ICS at the anterior axillary line and along the 9th ICS at the posterior axillary line. Robotic-assisted right transthoracic esophagogastrectomy and primary reanastomosis (with circular endostapler and orally-introduced anvil) were performed through the same thoracoscopy ports. Total operative (skin-to-skin) time was 517min, with RLLobectomy and MSLND taking 131min. Total intraoperative estimated blood loss was 100mL. Esophagram on postoperative day (POD)#4 revealed no anastomotic leak, and chest tube was removed on POD#6, but dysphagia delayed oral intake until POD#8, with nutrition via jejunostomy. Pseudomonas and E. coli jejunostomy site infection required antibiotics, but he was discharged home on POD#12 tolerating post-esophagectomy diet. Pathology revealed pT2N0M0 lung adenocarcinoma and no residual esophageal cancer. He was readmitted on POD#16 with aspiration pneumonia, contained anastomotic leak, and grade 1/2 sacral decubitus (treated with IV antibiotics, NPO with nutrition via jejunostomy, and sacral wound care) and discharged to skilled-nursing facility on hospital day#19. At 5-month follow-up, he was tolerating oral diet but had gastritis and small gastric ulcer, resolved with sucralfate by 8-month and 11-month follow-up.

DISCUSSION: Concurrent robotic-assisted RLLobectomy and Ivor-Lewis esophagogastrectomy was associated with postoperative complications related to feeding and nutritional intake.

CONCLUSIONS: We successfully performed the first reported concurrent robotic-assisted pulmonary lobectomy and robotic-assisted right transthoracic esophagogastrectomy.

Reference #1: None.

DISCLOSURE: The following authors have nothing to disclose: Eric Toloza, Lindsey Bendure, Christian Sobky, Joseph Garrett, Nasreen Vohra, Dale Han, David Kim, Kenneth Meredith

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