Zhu Ziyi, Luo Raojun, Li Zhijun, He Zhengfu, Xu Yong, Xu Shaohua, Yan Peijian
Department of Thoracic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
J Gastrointest Oncol. 2023 Feb 28;14(1):29-39. doi: 10.21037/jgo-22-1273. Epub 2023 Feb 20.
Lymph nodes dissection in esophagectomy is an essential procedure for radical resection, which can not only provide more accurate staging but may also improve survival, while it is technically challenging and may lead to recurrent laryngeal nerve (RLN) paralysis. Numerous efforts have been directed to achieve the dissection of more LNs around the RLN and to lower the incidence of RLN palsy, including Bascule method and modified Bascule method. On this basis, we modified and applied a novel method which involves the en bloc dissection of lymph nodes dissection along the left RLN in McKeown minimally invasive esophagectomy (MIE).
A total of 244 consecutive cases of lymphadenectomy along the left RLN during McKeown MIE at our institution between January 2018 and August 2021 were retrospectively analyzed. The cases were divided into two groups based on the methods of lymphadenectomy along the left RLN: 77 cases received the conventional method (CM group) and 167 cases received the novel method (NM group). The surgical outcomes, especially the impact of surgical proficiency on the outcomes of lymphadenectomy along the left RLN, were assessed and compared between the two groups.
Demographic data of the two cohorts were similar. The number of harvested lymph nodes (LNs) (total/abdomen/left RLN) in the NM group was markedly higher than that in the CM group (32 . 27, P=0.006; 11 . 9, P=0.038; 3 . 2, P=0.044). However, the number of harvested LNs from the chest or right RLN was not significantly different in the two groups. The hoarseness rate was 1.8% in the NM group, which was slightly but not notably lower than that of the CM group (1.8% . 2.6%, P=0.681). The incidence of LN metastasis along the left RLN was 13.9%, 15.6%, and 13.2% in the whole cohort, CM group, and NM group, respectively.
Our novel method not only increased the number of LN dissections along left RLN but also slightly reduced the incidence of hoarseness. Therefore, this novel method of lymphadenectomy along the left RLN during McKeown MIE is safe and reliable.
食管癌切除术中的淋巴结清扫是根治性切除的重要步骤，不仅能提供更准确的分期，还可能提高生存率，但其技术难度较大，可能导致喉返神经（RLN）麻痹。人们已做出诸多努力来实现对RLN周围更多淋巴结的清扫，并降低RLN麻痹的发生率，包括摇臂法和改良摇臂法。在此基础上，我们改良并应用了一种新方法，即在McKeown微创食管癌切除术（MIE）中沿左RLN整块清扫淋巴结。
回顾性分析了2018年1月至2021年8月期间在我院接受McKeown MIE的244例连续沿左RLN行淋巴结清扫的病例。根据沿左RLN的淋巴结清扫方法将病例分为两组：77例采用传统方法（CM组），167例采用新方法（NM组）。评估并比较两组的手术结果，尤其是手术熟练程度对沿左RLN淋巴结清扫结果的影响。
两组的人口统计学数据相似。NM组清扫的淋巴结数量（总数/腹部/左RLN）明显高于CM组（32.27，P = 0.006；11.9，P = 0.038；3.2，P = 0.044）。然而，两组从胸部或右RLN清扫的淋巴结数量无显著差异。NM组的声音嘶哑率为1.8%，略低于CM组，但差异不显著（1.8%.2.6%，P = 0.681）。整个队列、CM组和NM组沿左RLN的淋巴结转移发生率分别为13.9%、15.6%和13.2%。
我们的新方法不仅增加了沿左RLN清扫的淋巴结数量，还略微降低了声音嘶哑的发生率。因此，在McKeown MIE中沿左RLN进行淋巴结清扫的这种新方法是安全可靠的。
