P1.251. Minimally Invasive Technique of Esophagojejunal Reconstruction After Extended Total Gastrectomy for OG Junction Cancer

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – technique Background Esophagojejunal reconstruction following extended total gastrectomy for OG junction cancer is technically demanding due to limited lower mediastinal access and the requirement for a secure, tension-free anastomosis. Minimally invasive transhiatal approaches may reduce surgical morbidity while maintaining oncological adequacy. This study demonstrates the technical feasibility and surgical strategy of intracorporeal esophagojejunal reconstruction after laparoscopic extended total gastrectomy. Methods A laparoscopic extended total gastrectomy with transhiatal distal esophagectomy and D2 lymphadenectomy was performed for OG junction cancer. Lower mediastinal dissection and distal esophageal mobilization were completed transhiatally. Intracorporeal circular stapled esophagojejunostomy was performed, followed by jejunojejunostomy and diaphragmatic crural approximation. Operative steps, reconstructive techniques, and technical considerations were analyzed. Results The procedure was completed successfully using a totally minimally invasive transhiatal approach without thoracotomy. Adequate distal esophageal mobilization and lower mediastinal dissection were achieved safely. Intracorporeal esophagojejunal reconstruction was completed with satisfactory anastomotic alignment and tension-free reconstruction. The technique facilitated effective reconstruction within the confined mediastinal space while maintaining minimally invasive advantages. Conclusion Intracorporeal esophagojejunal reconstruction following laparoscopic extended total gastrectomy for OG junction cancer is feasible and reproducible in experienced minimally invasive upper GI surgical practice. The transhiatal approach allows safe lower mediastinal dissection and reconstruction while avoiding thoracotomy, offering valuable technical advantages in selected patients.