Zhu Zi-Yi, Luo Rao-Jun, He Zheng-Fu, Xu Yong, Xu Shao-Hua, Zhang Qiang
Department of Thoracic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Front Oncol. 2021 May 20;11:654674. doi: 10.3389/fonc.2021.654674. eCollection 2021.
Compared to open esophagectomy (OE), minimally invasive esophagectomy (MIE) is associated with lower morbidity and mortality. However, lymph node (LN) dissection around the recurrent laryngeal nerve (RLN) is still an important factor that affects the length of the learning curve of MIE. This study aims to evaluate the surgical outcomes of the first nearly 5-year period and explore the learning curve for LN dissection around the RLN in McKeown MIE by a new single surgical team.
A total of 285 consecutive patients who underwent McKeown MIE between March 2016 and September 2020 were included at our institution. According to the cumulative sum (CUSUM) analysis of LN dissection around the RLN, the patients were divided into three groups: exploration period, adjustment period, and stable period. We assessed the impact of surgical proficiency on postoperative outcomes and explored the learning curve for LN dissection around the RLN in McKeown MIE.
The CUSUM graph showed that a point of upward inflection for LN dissection around the RLN was observed in 151 cases. After 151 cases, LNs around the right and left RLNs were dissected thoroughly compared to the exploration and adjustment period (P = 0.010 and P = 0.012, respectively), and the postoperative incidence of hoarseness significantly decreased from 11.1 to 1.5% (P<0.001).
Our study results revealed that not only are the LN, around the RLN, sufficiently dissected but also the incidence of hoarseness significantly decreased in the stable phase. Consequently, the learning curve length was approximately 151 cases for LN dissection around the RLN in McKeown MIE.
与开放食管切除术（OE）相比，微创食管切除术（MIE）的发病率和死亡率更低。然而，喉返神经（RLN）周围的淋巴结（LN）清扫仍是影响MIE学习曲线长度的重要因素。本研究旨在评估首个近5年期间的手术结果，并探讨由单一手术团队进行的McKeown MIE中RLN周围LN清扫的学习曲线。
本机构纳入了2016年3月至2020年9月期间连续接受McKeown MIE的285例患者。根据RLN周围LN清扫的累积和（CUSUM）分析，将患者分为三组：探索期、调整期和稳定期。我们评估了手术熟练程度对术后结果的影响，并探讨了McKeown MIE中RLN周围LN清扫的学习曲线。
CUSUM图显示，151例患者出现了RLN周围LN清扫的向上拐点。151例之后，与探索期和调整期相比，左右RLN周围的LN清扫更为彻底（分别为P = 0.010和P = 0.012），术后声音嘶哑的发生率从11.1%显著降至1.5%（P<0.001）。
我们的研究结果显示，在稳定期不仅RLN周围的LN得到了充分清扫，而且声音嘶哑的发生率也显著降低。因此，McKeown MIE中RLN周围LN清扫的学习曲线长度约为151例。
