[Laparoscopic transhiatal right thoracic approach for lower esophageal and inferior mediastinal lymphadenectomy with digestive reconstruction in adenocarcinoma of the esophagogastric junction].

Objective: To explore the clinical application of totally laparoscopic lymph node dissection around the lower esophagus and in the inferior mediastinum combined with digestive tract reconstruction via the esophageal hiatus and right thoracic approach for adenocarcinoma of the esophagogastric junction (AEG). Methods: A retrospective analysis was performed on 4 patients with locally advanced Siewert type Ⅱ/Ⅲ AEG without distant metastasis. A combined exposure technique, including traction of the left diaphragmatic crus using barbed sutures and deliberate opening of the right pleura, was applied under laparoscopy to create an adequate operative space for lymph node dissection around the lower esophagus, inferior mediastinal lymphadenectomy and digestive tract reconstruction. Results: A total of 4 patients underwent this surgical procedure from November 2024 to September 2025, including 3 cases of Siewert type Ⅱ and 1 case of Siewert type Ⅲ. There were 3 patients with clinical T3 stage and 1 patient with clinical T4b stage, and the tumor diameter ranged from 1 cm to 10 cm. Two patients received neoadjuvant therapy preoperatively. All operations were completed totally laparoscopically without conversion to open laparotomy or thoracotomy. The operative time ranged from 243 to 340 minutes, and intraoperative blood loss was 50 to 100 ml. The number of harvested lymph nodes was 17 to 30. One patient developed right pleural effusion (Clavien-Dindo grade Ⅲa) postoperatively, which resolved after percutaneous puncture and drainage without thoracic infection. No other complications occurred in the remaining patients. Conclusion: The totally laparoscopic approach via the esophageal hiatus and right thorax serves as a novel alternative for minimally invasive radical resection of high-position AEG.