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Surgical Endoscopy
Published in: Surgical Endoscopy 1/2020

01-01-2020 | Esophageal Cancer

Mesenteric excision of upper esophagus: a concept for rational anatomical lymphadenectomy of the recurrent laryngeal nodes in thoracoscopic esophagectomy

Authors: Shigeru Tsunoda, Hisashi Shinohara, Seiichiro Kanaya, Hiroshi Okabe, Eiji Tanaka, Kazutaka Obama, Hisahiro Hosogi, Shigeo Hisamori, Yoshiharu Sakai

Published in: Surgical Endoscopy | Issue 1/2020

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Abstract

Background

The recurrent laryngeal nerve (RLN) lymph nodes are among the most frequently involved lymph nodes in esophageal cancer. Surgical removal of these lymph nodes is considered beneficial for postoperative prognosis, especially in patients with squamous cell carcinoma. Unfortunately, the precise surgical anatomy of the upper mediastinum is not well understood and no distinct high-resolution images are currently available.

Methods

In this article, we provide a simple intuitive concept of upper mediastinal surgical anatomy that could facilitate rational anatomical lymphadenectomy of the RLN lymph nodes. The essential concept of this mesenteric excision is to mobilize mesoesophagus including RLN in an en bloc fashion and to save RLN laterally by incising visceral sheath. This is applicable identically to both right and left upper mediastinum.

Results

Between January 2009 and December 2017, thoracoscopic esophagectomy with upper mediastinal lymphadenectomy for primary esophageal cancer was performed in 189 patients. Median thoracoscopic procedure time was 297 (range 205–568) min and median intraoperative blood loss was 70 ml (range unmeasurable up to 2545 ml). Median number of harvested upper mediastinal lymph nodes was 12. Postoperative complication of Clavien–Dindo classification grade III or higher events was observed in 14% of patients. RLN palsy of grade II or higher occurred in 20 patients (11%).

Conclusion

The mesoesophagus in the upper mediastinum is an anatomical unit surrounded by fibrous connective tissue containing the esophagus, trachea, tracheoesophageal vessels, lymphatic tissue, and RLNs. Thus, mesenteric excision of esophagus is defined to resect this area by sparing trachea and RLNs for rational anatomical lymphadenectomy. We believe that this concept makes upper mediastinal lymphadenectomy safer and more appropriate.
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Metadata
Title
Mesenteric excision of upper esophagus: a concept for rational anatomical lymphadenectomy of the recurrent laryngeal nodes in thoracoscopic esophagectomy
Authors
Shigeru Tsunoda
Hisashi Shinohara
Seiichiro Kanaya
Hiroshi Okabe
Eiji Tanaka
Kazutaka Obama
Hisahiro Hosogi
Shigeo Hisamori
Yoshiharu Sakai
Publication date
01-01-2020
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 1/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-06741-x

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