Cervical Incision-Free Technique for R0 Resection in Cervicothoracic Esophageal Carcinoma: A Novel Approach of the Chai's Supra-Thoracic Apex Technique.

Abstract

Purpose: Esophageal squamous cell carcinoma (ESCC) located at the cervicothoracic junction (CTJ-ESCC), approximately 18-21 cm from the incisors, poses unique surgical difficulties given its proximity to the trachea and recurrent laryngeal nerves. This investigation evaluated a new approach that avoids cervical incisions by combining the EGIARADMT™ curvilinear stapling method with OrVil™-based three-dimensional suspension anastomosis (TriSAS) to achieve R0 resection. Methods: A retrospective analysis was performed on 11 consecutive cases of CTJ-ESCC treated between February 2019 and March 2024, with follow-up data available until February 2025. Results: All patients underwent R0 resection without cervical incisions, achieving a proximal margin of 1-4 cm. The median operative time was 350 minutes (range: 275-605) with a blood loss of 100 mL (range: 20-700). Lymphadenectomy resulted in a median of 21 nodes (range: 9-38) being retrieved. The median duration of hospitalization was 49 days (range: 42-67). There were no occurrences of anastomotic leaks, strictures, or recurrent laryngeal nerve injuries. Transient gastric stasis was observed in 18.2% of cases and resolved with conservative management. One postoperative mortality was attributed to pulmonary infection. The median overall and disease-free survival were 25 months. Conclusion: Integrating EGIARADMT curvilinear stapling with OrVil-TriSAS anastomosis enables cervical incision-free R0 resection for CTJ-ESCC, achieving precise oncologic control with functional preservation. Adjuvant therapy may further improve survival despite clear margins.