Thoraco-laparoscopic Partial Esophagogastrectomy for Management of Esophageal Cancer

"1. Laparoscopic Phase:~ * The stomach is mobilized, and a part of it is resected to include the lower esophageal segment.~ * Left gastric nodes, the splenic and common hepatic nodes are dissected.~ * A gastric tube is created using endoscopic staplers for esophageal reconstruction and fixed to the proximal gastrectomy specimen using sutures~2. Thoracoscopic Phase:~ * The patient is positioned in prone position~ * Three small incisions are made in the thorax~ * Further esophageal mobilization through a right thoracoscopy is performed in left lateral decubitus. Periesophageal nodes are retrieved en bloc. Left and right paratracheal and subcarinal lymph nodes are resected separately. The esophagus is transected at the tumor's proximal margin.~3. Reconstruction:~ * An anastomosis (esophagogastric connection) is performed to restore continuity, typically using a circular stapler or hand-sewn technique."