Anand Santosh, Kalayarasan Raja, Chandrasekar Sandip, Gnanasekaran Senthil, Pottakkat Biju
Department of Surgical Gastroenterology, JIPMER, Room no 551, Fourth floor, Superspeciality block, Puducherry, 605006, India.
J Gastrointest Cancer. 2019 Jun;50(2):230-235. doi: 10.1007/s12029-018-0051-1.
Neoadjuvant therapy followed by surgery is the current recommended treatment for locally advanced esophageal carcinoma. Thoracic duct (TD) resection was indicated for radical mediastinal lymphadenectomy. However, TD resection can cause hemodynamic disturbances. The presence of metastasis in TD has not been previously studied.
Twenty-two patients who underwent minimally invasive esophagectomy with D2 lymphadenectomy after neoadjuvant chemoradiotherapy for esophageal squamous cell carcinoma were analyzed. Ten patients had their TD resected from thoracic inlet till the esophageal hiatus. Multiple histopathological sections of the TD were examined for evidence of tumor spread. Intraoperative and immediate (48 h) postoperative hemodynamic parameters, lymph node yield, and postoperative morbidity were compared between TD-resected and TD-preserved groups.
The median postoperative day 1 fluid requirement (3310 mL vs. 2875 mL, P = 0.059) and the median postoperative day 2 pulse rate were higher in the TD-resected group (111/min vs. 95/min, P = 0.043). There was no significant difference in the intraoperative fluid infusion, blood loss, urine output, mean blood pressure, pulse rate, postoperative urine output, and mean blood pressure between two groups. Median (range) mediastinal lymph node count was similar in TD-resected and TD-preserved groups [15(11-32) vs. 14(9-31), P = 0.283]. Pathological examination of TD did not reveal tumor cells in any of the patients. There was no significant difference in the postoperative morbidity between two groups except for cervical anastomotic dehiscence (P = 0.007).
Minimally invasive esophagectomy with TD resection causes minor hemodynamic changes in the immediate postoperative period, without adversely affecting the postoperative outcome. In the setting of neoadjuvant chemoradiotherapy, TD resection does not increase lymph node yield.
新辅助治疗后行手术是目前局部晚期食管癌的推荐治疗方法。胸段食管切除术适用于根治性纵隔淋巴结清扫。然而，胸段食管切除可能导致血流动力学紊乱。此前尚未对胸段食管内转移情况进行研究。
分析22例接受新辅助放化疗后行微创食管癌切除术及D2淋巴结清扫术的食管鳞状细胞癌患者。10例患者的胸段食管从胸廓入口至食管裂孔被切除。对胸段食管的多个组织病理学切片进行检查以寻找肿瘤播散的证据。比较胸段食管切除组和保留胸段食管组的术中及术后即刻（48小时）血流动力学参数、淋巴结收获量及术后发病率。
胸段食管切除组术后第1天的液体需求量中位数（3310毫升对2875毫升，P = 0.059）及术后第2天的脉搏率中位数较高（111次/分钟对95次/分钟，P = 0.043）。两组间术中液体输注量、失血量、尿量、平均血压、脉搏率、术后尿量及平均血压无显著差异。胸段食管切除组和保留胸段食管组的纵隔淋巴结计数中位数（范围）相似[15（11 - 32）对14（9 - 31），P = 0.283]。胸段食管的病理检查未在任何患者中发现肿瘤细胞。除颈部吻合口裂开外，两组术后发病率无显著差异（P = 0.007）。
行胸段食管切除的微创食管癌切除术在术后即刻引起轻微血流动力学变化，对术后结局无不良影响。在新辅助放化疗的情况下，胸段食管切除不会增加淋巴结收获量。
