Department of Surgery, Osaka Red Cross Hospital, 5-30 Fudegasakicho, Tennoji-ku, Osaka, 543-8555, Japan.
Esophagus. 2019 Jul;16(3):324-329. doi: 10.1007/s10388-019-00664-1. Epub 2019 Apr 3.
Effective treatment of esophageal cancer requires dissection of the regional lymph nodes (LNs) from the cervical to the abdominal area. In this study, we hypothesized that adequate no. 101R dissection is achieved through a thoracoscopic approach in the prone position.
The study cohort was limited to 42 patients who underwent thoracoscopic subtotal esophagectomy with bilateral cervical lymphadenectomy for thoracic esophageal cancer between January 2015 and March 2017. The number of LNs and the incidence of metastasis were analyzed. During the proposed thoracoscopic procedure, cervical paraesophageal LNs were dissected continuously, with the LNs surrounding the recurrent laryngeal nerve (RLN; no. 106rec) as an en bloc resection. In this study, LNs that required further picking up via a cervical incision were defined as no. 101. The recurrent sites among the consecutive patients during the 3-year follow-up, for whom bilateral cervical lymphadenectomy was omitted for lower and middle thoracic tumors between 2012 and 2014, were analyzed further.
The data of 42 patients were analyzed. The lymphatic tissues dorsal to the right cervical RLN were almost completely dissected via thoracoscopy. A median of 0 (0-6) LNs were ventral to the right RLN (no. 101R) and no LN metastasis was observed. There were no lymph nodes in 27 patients (64%). By contrast, there was a median of 1(0-10) no. 101L nodes, and LN metastasis was observed in two patients (4.7%). The numbers of LNs at no. 106recR and no. 106recL were 3 (0-9) and 2(0-13), respectively, and the corresponding numbers of patients with metastases at these sites were 11(26%) and 5(12%), respectively. Among the 33 patients who completed the 3-year follow-up, 9 patients developed recurrence, but none involved 101R LNs.
There were no residual LNs in the area ventral to the right cervical RLN in 64% of the patients who underwent additional cervical lymphadenectomy after the right thoracoscopic approach in the prone position. Further studies with larger patient cohort or randomization are required to confirm our results.
有效的食管癌治疗需要从颈部到腹部区域解剖区域淋巴结（LNs）。在这项研究中，我们假设通过俯卧位胸腔镜入路可以实现充分的 101R 清扫。
研究队列仅限于 42 名患者，他们在 2015 年 1 月至 2017 年 3 月期间接受了胸腔镜辅助下根治性食管切除术和双侧颈部淋巴结清扫术治疗胸段食管癌。分析了淋巴结数量和转移发生率。在提出的胸腔镜手术过程中，连续地解剖颈侧食管旁淋巴结，将环绕喉返神经（RLN）的淋巴结（no.106rec）整块切除。在这项研究中，通过颈部切口进一步取出的淋巴结定义为 no.101。进一步分析了在 2012 年至 2014 年间因中下胸段肿瘤而省略双侧颈部淋巴结清扫术的连续患者在 3 年随访期间的复发部位。
分析了 42 名患者的数据。通过胸腔镜几乎可以完全清除右颈 RLN 背侧的淋巴组织。右 RLN 腹侧中位数为 0（0-6）个淋巴结（no.101R），未见淋巴结转移。27 名患者（64%）无淋巴结。相比之下，no.101L 有中位数 1（0-10）个淋巴结，2 名患者（4.7%）有淋巴结转移。no.106recR 和 no.106recL 的淋巴结数分别为 3（0-9）和 2（0-13），相应的转移患者数分别为 11（26%）和 5（12%）。在完成 3 年随访的 33 名患者中，9 名患者出现复发，但均未累及 101R 淋巴结。
在俯卧位右侧胸腔镜入路后行额外的颈部淋巴结清扫术的患者中，64%的患者右颈 RLN 腹侧无残留淋巴结。需要更大患者队列或随机分组的进一步研究来证实我们的结果。
