Mao Y S, He J, Gao S G, Xue Q, Yuan L G, Zhao Y, Ding N N
Department of Thoracic Surgery, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
Zhonghua Zhong Liu Za Zhi. 2019 Jan 23;41(1):1-5. doi: 10.3760/cma.j.issn.0253-3766.2019.01.001.
Esophageal cancer is one of the most prevalent cancers in China. Lymph node metastasis is one of the most important prognostic factors and severely affect the long-term survival after surgical treatment. Therefore, systemic two-field lymph node dissection including thoracic and abdominal draining nodes of the esophagus during surgery is essential in order to improve the long-term survival for the patients with thoracic esophageal cancer, and it is also the basis for precise staging and postoperative adjuvant treatment regimen- making. As reported in the literature, lymph node metastases along bilateral recurrent laryngeal nerve was the highest, therefore, the lymph node dissection along bilateral recurrent laryngeal nerve is the most important manipulation during esophagectomies, however, it is also the most technically difficult procedure during operation. It usually results in postoperative complications especially the respiratory complications due to paralysis of recurrent laryngeal nerves caused by lymph node dissection. Therefore, the gain and loss of lymph node dissection along bilateral recurrent laryngeal nerve has been a disputed and entangle topic for thoracic surgeons, and the purpose of this paper is to summarize author's experience and the key technology to prevent the associated complications in lymph node dissection along recurrent laryngeal nerve during esophagectomies for the patients with thoracic esophageal cancer.
食管癌是中国最常见的癌症之一。淋巴结转移是最重要的预后因素之一,严重影响手术治疗后的长期生存。因此,为提高胸段食管癌患者的长期生存率,手术中进行包括胸段和腹段食管引流淋巴结的系统性二野淋巴结清扫至关重要,这也是精确分期和制定术后辅助治疗方案的基础。据文献报道,双侧喉返神经旁淋巴结转移率最高,因此,双侧喉返神经旁淋巴结清扫是食管癌切除术中最重要的操作,但也是手术中技术难度最大的步骤。它通常会导致术后并发症,尤其是由于淋巴结清扫导致喉返神经麻痹引起的呼吸并发症。因此,双侧喉返神经旁淋巴结清扫的得失一直是胸外科医生争论和纠结的话题,本文旨在总结作者在胸段食管癌患者食管癌切除术中进行喉返神经旁淋巴结清扫的经验及预防相关并发症的关键技术。