Davakis Spyridon, Ziogas Dimitrios, Papadakis Pavlos, Sakellariou Stratigoula, Mitsala Athanasia, Tsalikidis Christos, Charalabopoulos Alexandros
Upper Gastrointestinal and General Surgery Unit, First Department of Surgery, National and Kapodistrian Universtity of Athens, Laiko General Hospital, 11527 Athens, Greece.
First Department of Internal Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece.
J Clin Med. 2024 Nov 16;13(22):6896. doi: 10.3390/jcm13226896.
Esophagectomy is the mainstay of treatment in esophageal cancer. Minimally invasive esophagectomy (MIE) remains a challenging procedure and has been associated with a high rate of complications and mortality. Routine lymphadenectomy includes two-field lymphadenectomy for distal-esophageal or gastroesophageal junction Siewert I-II tumors. Superior mediastinal lymphadenectomy (SML) refers to an extended two-field lymphadenectomy or total mediastinal lymphadenectomy during MIE for cancer. The exact benefits of SML have been the subject of prolonged debate, with no conclusive evidence indicating improved clinical and oncological results. Herein, we aim to present our surgical technique of thoracoscopic SML during MIE in the prone position, with short-term clinical and oncological outcomes. About 150 consecutive patients underwent totally MIE within 3 years period (2016-2019). SML included right-paratracheal nodes and nodes along the right-recurrent laryngeal nerve throughout its mediastinal route in cases of extended two-field lymphadenectomy, as well as left-paratracheal nodes and nodes along the left recurrent laryngeal nerve during total mediastinal lymphadenectomy. Eligible patients underwent SML during two-stage or three-stage MIE. Twenty consecutive patients underwent SML during the study period. The 30- and 90-day mortality rates were 0. Pulmonary complications were observed in 16.5% of the patients. There was 1 right recurrent laryngeal nerve palsy noted. The median length of stay was 9 days. The median number of resected lymph nodes was 45, with the median SML nodes count being 8. The median follow-up was 24 months. SML during prone position thoracoscopy for esophageal cancer is safe and feasible, although technically demanding. Minimally invasive esophagectomy with SML may offer meaningful benefits in oncological outcomes without introducing additional significant morbidity. Further comparative studies are needed to better elucidate our results.
食管癌切除术是食管癌治疗的主要手段。微创食管癌切除术（MIE）仍然是一项具有挑战性的手术，且与高并发症发生率和死亡率相关。常规淋巴结清扫包括对远端食管癌或胃食管交界部Siewert I-II型肿瘤进行两野淋巴结清扫。上纵隔淋巴结清扫（SML）是指在MIE治疗癌症期间进行的扩大两野淋巴结清扫或全纵隔淋巴结清扫。SML的确切益处一直是长期争论的主题，尚无确凿证据表明其能改善临床和肿瘤学结果。在此，我们旨在介绍我们在俯卧位MIE期间进行胸腔镜SML的手术技术，以及短期临床和肿瘤学结果。在3年期间（2016 - 2019年），约150例连续患者接受了全MIE。在扩大两野淋巴结清扫的情况下，SML包括右气管旁淋巴结以及沿右喉返神经全程纵隔走行的淋巴结；在全纵隔淋巴结清扫期间，还包括左气管旁淋巴结以及沿左喉返神经的淋巴结。符合条件的患者在两阶段或三阶段MIE期间接受SML。在研究期间，20例连续患者接受了SML。30天和90天死亡率为0。16.5%的患者出现肺部并发症。记录到1例右侧喉返神经麻痹。中位住院时间为9天。切除淋巴结的中位数为45个，SML淋巴结计数中位数为8个。中位随访时间为24个月。食管癌俯卧位胸腔镜下SML虽然技术要求高，但安全可行。MIE联合SML在肿瘤学结果方面可能带来有意义的益处，且不会增加额外的显著发病率。需要进一步的比较研究以更好地阐明我们的结果。
