Xiao Wenguang, Ma Ke, Peng Lin, Chen Lihua, He Jintao, Li Qiang, Han Yongtao
Department of Thoracic Surgery, Sichuan Provincial Tumor Hospital, Chengdu 610041, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2014 Sep;17(9):911-4.
To compare thoracoscopic esophagectomy with traditional esophagectomy in radical mediastinal lymphadenectomy for esophageal cancer, and to explore the feasibility and safety of thoracoscopic mediastinal lymphadenectomy for esophagectomy.
Clinical data associated with perioperation and mediastinal lymph nodes clearance of 304 patients undergoing radical operation of esophageal cancer via left neck-right chest-upper abdomen in our department from June 2009 to June 2011 were analyzed retrospectively. Among 304 cases, 199 received traditional open radical resection and 105 thoracoscopic esophagectomy. The intrathoracic mediastinal lymph node metastasis rate, extent of metastasis, time of operation, blood loss and complications between two groups were compared.
All the 304 cases completed their operations successfully. A total of 3724 mediastinal lymph nodes were removed, mean 12.3±7.0 per case, including 1065 in thoracoscopic group, mean 10.1±5.5 per case, and 2659 in open group, mean 13.3±7.5 per case, whose difference was significant. But further analysis according to the postoperative pathologic staging showed no significant difference of above lymph nodes removed between two groups. Mediastinal lymph node metastasis was found in 126 patients with a rate of 41.4%, which was 35.6% and 44.7% in thoracoscopic and open groups respectively without significant difference(P>0.05). The left laryngeal recurrent nerve lymph node metastasis rate in open group and thoracoscopic group was 16.1% and 6.7% respectively, and the difference was significant(P<0.05). Differences of lymph node metastasis rate in other regions were not significant between the two groups. There were 365 positive lymph nodes, and the lymph node metastasis degree was 9.8%. which was 8.2% and 10.5% in thoracoscopic group and open group respectively(P<0.05), besides metastasis degree of open group was much higher in right laryngeal recurrent nerve and subcarinal lymph node region. The overall complication rate was 36.8%, which was 28.6% in thoracoscopic group and 41.2% in open group respectively with significant difference(P<0.05). There were no significant differences in operative time and blood loss between the two groups(both P>0.05).
Radical mediastinal lymphadenectomy with thoracoscopic esophagectomy is technically safe and feasible for early to moderate stage esophageal cancer with similar lymph nodes removed and lower complication morbidity. In the early period of carrying out thoracoscopic radical mediastinal lymphadenectomy, laryngeal recurrent nerve and subcarinal lymph node region should be identified to prevent incidental injury.
比较胸腔镜食管癌切除术与传统食管癌切除术在根治性纵隔淋巴结清扫方面的效果，探讨胸腔镜纵隔淋巴结清扫在食管癌切除术中的可行性与安全性。
回顾性分析2009年6月至2011年6月在我科行经左颈 - 右胸 - 上腹食管癌根治术的304例患者的围手术期及纵隔淋巴结清扫相关临床资料。304例患者中，199例行传统开放根治性切除术，105例行胸腔镜食管癌切除术。比较两组患者的胸内纵隔淋巴结转移率、转移范围、手术时间、出血量及并发症情况。
304例患者均成功完成手术。共切除纵隔淋巴结3724枚，平均每例12.3±7.0枚，其中胸腔镜组1065枚，平均每例10.1±5.5枚，开放组2659枚，平均每例13.3±7.5枚，差异有统计学意义。但根据术后病理分期进一步分析显示，两组切除的上述淋巴结数量无显著差异。126例患者发现纵隔淋巴结转移，转移率为41.4%，胸腔镜组和开放组分别为35.6%和44.7%，差异无统计学意义（P>0.05）。开放组和胸腔镜组左侧喉返神经淋巴结转移率分别为16.1%和6.7%，差异有统计学意义（P<0.05）。两组其他区域淋巴结转移率差异无统计学意义。阳性淋巴结365枚，淋巴结转移度为9.8%，胸腔镜组和开放组分别为8.2%和10.5%（P<0.05），此外开放组在右侧喉返神经和隆突下淋巴结区域的转移度更高。总体并发症发生率为36.8%，胸腔镜组为28.6%，开放组为41.2%，差异有统计学意义（P<0.05）。两组手术时间和出血量差异无统计学意义（均P>0.05）。
胸腔镜食管癌根治性纵隔淋巴结清扫术对于早中期食管癌在技术上是安全可行的，清扫淋巴结数量相近且并发症发生率较低。在开展胸腔镜根治性纵隔淋巴结清扫术的早期，应注意识别喉返神经和隆突下淋巴结区域，防止意外损伤。
