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Surgical Endoscopy

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01-01-2021 | Esophageal Cancer

Microanatomy-based standardization of left upper mediastinal lymph node dissection in thoracoscopic esophagectomy in the prone position

Authors: Yasuhiro Shirakawa, Kazuhiro Noma, Naoaki Maeda, Shunsuke Tanabe, Kazufumi Sakurama, Toshiyoshi Fujiwara

Published in: Surgical Endoscopy | Issue 1/2021

Abstract

Background

Although thoracoscopic esophagectomy in the prone position (TEPP) has become a standard procedure for esophageal cancer surgery, upper mediastinal lymph node dissection (UMLND) on the left side remains an issue. We have recently developed a new standardized approach to left UMLND in TEPP based on the microanatomy of the membranes and layers with the aim of achieving quick and safe surgery. The purpose of this study was to establish and evaluate our new standardized procedure in left UMLND.

Patients and methods

Patients were divided into 2 groups: a pre-standardization group (n = 100) and a post-standardization group (n = 100). Eventually, 83 paired cases were matched using propensity score matching. In our new standardized procedure, left UMLND was performed while focusing on the visceral sheath, vascular sheath, and the fusion layer between them using a magnified view.

Results

The thoracoscopic operative time was significantly shorter (P < 0.001) in the post-standardization group [n = 83; 209.0 (176.0–235.0) min] than in the pre-standardization group [n = 83; 235.5 (202.8–264.5) min]. No significant differences were found in the number of mediastinal lymph nodes dissected or intraoperative blood loss between the two groups. There was a tendency for the total postoperative morbidity to decrease in the post-standardization group. Furthermore, the left recurrent laryngeal nerve palsy rate was significantly lower in the post-standardization group (18.1% to 8.7%, P = 0.015).

Conclusion

Microanatomy-based standardization contributes to safe and efficient left UMLND.

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Title: Microanatomy-based standardization of left upper mediastinal lymph node dissection in thoracoscopic esophagectomy in the prone position
Authors: Yasuhiro Shirakawa
Kazuhiro Noma
Naoaki Maeda
Shunsuke Tanabe
Kazufumi Sakurama
Toshiyoshi Fujiwara
Publication date: 01-01-2021
Publisher: Springer US
Keywords: Esophageal Cancer
Esophagus Resection
Esophageal Cancer
Esophagus Resection
Published in: Surgical Endoscopy / Issue 1/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07407-9

At a glance: The STEP trials

Springer Medicine

Microanatomy-based standardization of left upper mediastinal lymph node dissection in thoracoscopic esophagectomy in the prone position

Abstract

Background

Patients and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Patients and methods

Results

Conclusion

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