Oshikiri Taro, Nakamura Tetsu, Hasegawa Hiroshi, Yamamoto Masashi, Kanaji Shingo, Yamashita Kimihiro, Matsuda Takeru, Sumi Yasuo, Suzuki Satoshi, Kakeji Yoshihiro
Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan.
Ann Surg Oncol. 2017 Apr;24(4):1018. doi: 10.1245/s10434-016-5749-3. Epub 2017 Jan 5.
Lymphadenectomy along the left recurrent laryngeal nerve (RLN) in esophageal cancer is important for disease control but requires advanced dissection skills. We previously reported a reliable method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the prone position (TEP). The goal of this method is complete dissection of the lymph nodes along the left RLN in a safe manner.
This procedure is performed for all resectable thoracic esophageal cancers. The essence of the method is to recognize the lateral pedicle as a two-dimensional membrane that includes the left RLN, lymph nodes, and primary esophageal arteries. By drawing the proximal portion of the divided esophagus and the lateral pedicle, identification and reliable cutting of the primary esophageal arteries, as well as distinguishing the left RLN from the lymph nodes, becomes simplified.
We performed 46 TEPs using this method, with no conversion to an open procedure, at Kobe University in 2015. The body mass index of these patients was distributed between 19 and 32, and the mean number of harvested lymph nodes along the left RLN was 6.9 ± 4.2. Left RLN palsy greater than Clavien-Dindo classification grade II occurred in four patients (8% )without permanent paralysis, while the incidence of lymph node metastasis along the left RLN was 22%.
Our method for lymphadenectomy along the left RLN during TEP is safe and reliable. It has a low incidence of left RLN palsy and provides sufficient lymph node dissection along the left RLN.
食管癌手术中沿左喉返神经（RLN）进行淋巴结清扫对疾病控制很重要，但需要高超的解剖技巧。我们之前报道了一种在俯卧位胸腔镜食管切除术（TEP）期间沿左RLN进行淋巴结清扫的可靠方法。该方法的目标是以安全的方式完整清扫沿左RLN的淋巴结。
对所有可切除的胸段食管癌均采用此手术方法。该方法的关键在于将外侧蒂视为包含左RLN、淋巴结和食管主要动脉的二维膜。通过牵拉切断食管的近端和外侧蒂，食管主要动脉的识别和可靠切断以及左RLN与淋巴结的区分变得更加简单。
2015年我们在神户大学使用该方法进行了46例TEP手术，无一例转为开放手术。这些患者的体重指数在19至32之间，沿左RLN清扫的淋巴结平均数量为6.9±4.2。4例患者（8%）出现大于Clavien-Dindo分类二级的左RLN麻痹，但无永久性麻痹，而沿左RLN的淋巴结转移发生率为22%。
我们在TEP期间沿左RLN进行淋巴结清扫的方法安全可靠。左RLN麻痹发生率低，且能沿左RLN进行充分的淋巴结清扫。
