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Journal of Gastrointestinal Surgery

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01-04-2012 | Original Article

Extensive Mediastinal Lymphadenectomy During Minimally Invasive Esophagectomy: Optimal Results from a Single Center

Authors: Yaxing Shen, Yi Zhang, Lijie Tan, Mingxiang Feng, Hao Wang, Muhammad Asim Khan, Mingqiang Liang, Qun Wang

Published in: Journal of Gastrointestinal Surgery | Issue 4/2012

Abstract

Introduction

Recent advances in thoracoscopic surgery have made it possible to perform esophagectomy with conventional lymphadenectomy (paraesophageal and subcarinal lymph node dissection) using minimally invasive techniques. However, minimally invasive esophagectomy (MIE) combined with extensive lymphadenectomy along the recurrent laryngeal nerves (RLN) has remained technically challenging for thoracic surgeons. The aim of this study was to examine the safety and efficacy of extensive lymphadenectomy when compared to conventional lymphadenectomy during MIE.

Methods

We retrospectively reviewed data from a cohort of 147 consecutive patients who underwent MIE for esophageal cancer (EC) over a 3-year period at our institution. During thoracoscopic esophagectomy, extensive lymphadenectomy along the RLN was performed on 76 patients from June 2009 to December 2010 (group A), while 71 patients underwent conventional lymphadenectomy from June 2008 to May 2009 (group B) and were enrolled as historical controls. Clinical characteristics including patient demographics, operation features, and the rate and type of complications were recorded for both groups. The number of dissected lymph nodes and the number of patients with nodes positive for cancer on histological examination were determined for both groups. Statistical analysis was used to identify differences between the two groups.

Results

All patients underwent thoracoscopic esophagectomy without conversion to open thoracotomy. Patient demographics and operation features were similar between the two groups. Of the 76 patients that underwent extensive lymphadenectomy there were 13 patients (17.11%) who were RLN positive, which resulted in upstaging of TNM in 5 patients (6.58%). The overall incidence of postoperative complications (42.10% versus 39.47%, p = 0.742) and permanent recurrent laryngeal nerve palsy (1.32% versus 0%, p = 0.517) was similar between the two groups.

Conclusions

Extensive mediastinal lymphadenectomy during minimally invasive esophagectomy is a feasible procedure for EC patients. It is technically safe and oncologically adequate in experienced hands, and improves the accuracy of tumor staging. Further study is required to discuss its long-term prognostic value for esophagus cancer patients.

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Title: Extensive Mediastinal Lymphadenectomy During Minimally Invasive Esophagectomy: Optimal Results from a Single Center
Authors: Yaxing Shen
Yi Zhang
Lijie Tan
Mingxiang Feng
Hao Wang
Muhammad Asim Khan
Mingqiang Liang
Qun Wang
Publication date: 01-04-2012
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 4/2012
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-012-1824-7

At a glance: The STEP trials

Springer Medicine

Extensive Mediastinal Lymphadenectomy During Minimally Invasive Esophagectomy: Optimal Results from a Single Center

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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