Mediastinoscopy-assisted esophagectomy is useful technique for poor surgical-risk patients with thoracic esophageal cancer.

Elderly and poor surgical-risk patients with esophageal cancer experience several complications and often cannot undergo standard transthoracic esophagectomy. Mediastinoscopy-assisted esophagectomy (MAE) recently has been applied in patients with thoracic esophageal cancer. We herein report 2 poor surgical-risk patients of lower thoracic esophageal cancer treated with MAE. Patient 1 was a 60-year-old man with respiratory impairment due to pulmonary tuberculosis whereas patient 2 was an 80-year-old man with poor performance status and nutritional condition. In these patients, MAE was performed because standard esophagectomy by thoracotomy is too difficult to perform. We performed MAE using the mediastinoscope approaches via both the neck and hiatus. An approach via the hiatus is useful for mobilization of lower thoracic esophagus and via the neck is useful for direct visualization of recurrent nerve. These patients were successfully treated without complications. MAE enables the mobilization of the thoracic esophagus under the direct visualization in the mediastinum, and it may be considered to be safe and useful technique for elderly and poor surgical-risk patients.