P1.182. Development of Difficulty Prediction Method for Mediastinoscopic Esophagectomy in Esophageal Cancer

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer Background Mediastinoscopic esophagectomy is a minimally invasive procedure for esophageal cancer, but no established method exists to predict surgical difficulty. This study aimed to identify a difficulty factor of this technique and develop a novel scoring system to predict the difficulty of mediastinoscopic esophagectomy for esophageal cancer. Methods A total of 192 patients who underwent radical mediastinoscopic esophagectomy between 2019 and 2024 at the University Hospital, Kyoto Prefectural University of Medicine were retrospectively analyzed. Forty-three patients were defined as Hard case of this technique based on operative time or blood loss exceeded the mean plus one standard deviation, and conversion to thoracotomy. Five difficulty factors (DFs) were identified based on relationships between Hard group and clinicopathological features in univariate analysis. The DFs were scored to classify cases into three difficulty levels, Difficult, Moderate, and Easy. Associations between the three difficulty levels and clinicopathological variables, operative outcomes, and postoperative complications were assessed. Results Forty-three patients were defined as the Hard group based on surgical time, blood loss (391 minutes or 253 g, respectively), or four cases of conversion to thoracotomy. Five difficulty factors (DFs), Male, pre-treatment (ESD or NAC), advanced cStage (III-IV), short aorta distance (≦33mm), and tumor location, were identified and scored to create a difficulty classification system with three levels: Easy, Moderate, and Difficult. Higher difficulty levels were significantly associated with 5 DFs, prolonged operative time, and tumor progression (T and N factors) (p< 0.01, respectively). Furthermore, they were also correlated with postoperative respiratory complications (p= 0.02). Although other complications, such as recurrent laryngeal nerve paralysis and anastomotic leakage, tended to increase in difficult cases, these differences were not statistically significant. Conclusion We developed a novel scoring system for evaluating the difficulties of radical mediastinoscopic esophagectomy. This scoring system may predict not only surgical courses, such as surgical time, blood loss, and transcervical subcarinal lymphadenectomy, but also postoperative complications, especially respiratory complications. It enables preoperative prediction of surgical difficulty of mediastinoscopic esophagectomy and may facilitate safe introduction, appropriate patient selection, reduce postoperative complications, and standardization of this minimally invasive technique in clinical practice.