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Surgery Today
Published in: Surgery Today 3/2018

01-03-2018 | Original Article

Anatomical study of the left superior mediastinal lymphatics for tracheal branches of left recurrent laryngeal nerve-preserving mediastinoscope-assisted surgery in esophageal cancer

Authors: Yutaka Nakajima, Yutaka Tokairin, Yasuaki Nakajima, Kenro Kawada, Kagami Nagai, Kumiko Yamaguchi, Keiichi Akita, Tatsuyuki Kawano

Published in: Surgery Today | Issue 3/2018

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Abstract

Purpose

Curative treatment of esophageal cancer requires meticulous superior mediastinal lymphadenectomy, in addition to esophagectomy, because superior mediastinal lymph node metastases are common in esophageal cancer. When preserving the tracheal branches of the left recurrent laryngeal nerve (RLN), good anatomical understanding is required for confirmation of the positional relationships between the courses of lymphatic vessels, lymph node distribution, and the left RLN and its tracheal branches. We performed a detailed anatomical examination of these relationships.

Methods

Macroscopic anatomical observation and histological examination was performed on cadavers. In addition to hematoxylin and eosin staining, immunostaining using antipodoplanin antibody D2-40 (podoplanin) was performed to identify the lymphatic vessels.

Results

The tracheal branches of the left RLN were clearly observed, but no lymphatic vessels crossing the ventral or dorsal side of the branches were identified either macro-anatomically or histologically.

Conclusion

No complex lymphatic network structure straddling the plane composed of tracheal branches of the left RLN was found in the left superior mediastinum. This suggests that dissection of the lymph nodes around the left RLN via the pneumomediastinum method using the left cervical approach may allow preservation of the tracheal branches of the left RLN by maintaining dissection accuracy.
Literature
1.
Kato H, Tachimori Y, Mizobuchi S, Igaki H, Ochiai A. Cervical, mediastinal, and abdominal lymph node dissection (three-field dissection) for superficial carcinoma of the thoracic esophagus. Cancer. 1993;72:2879–82.CrossRefPubMed
2.
Paleru C, Danaila O, Bolca C, Cordos I. Complications of mediastinoscopy. Pneumologia 2009;58:39–40, 42.
3.
Fukukei I, Tabuchi S. Section of rami bronchiales of the vagus nerve as the treatment of severe bronchial asthma. Jpn J Thorac Surg. 1964;12:1002–10.
4.
Monfared A, Gorti G, Kim D. Microsurgical anatomy of the laryngeal nerves as related to thyroid surgery. Laryngoscope. 2002;112:386–92.CrossRefPubMed
5.
Monfared A, Kim D, Jaikumar S, Gorti G, Kam A. Microsurgical anatomy of the superior and recurrent laryngeal nerves. Neurosurgery 2001;49:925–32; discussion 932–23.
6.
O’Donnell RK, Feldman M, Mick R, Muschel RJ. Immunohistochemical method identifies lymphovascular invasion in a majority of oral squamous cell carcinomas and discriminates between blood and lymphatic vessel invasion. J Histochem Cytochem. 2008;56:803–10.CrossRefPubMedPubMedCentral
7.
Katayama H, Kurokawa Y, Nakamura K, et al. Extended Clavien–Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46:668.CrossRefPubMed
8.
Cuschieri A, Shimi S, Banting S. Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb. 1992;37:7–11.PubMed
9.
Law S, Fok M, Chu KM, Wong J. Thoracoscopic esophagectomy for esophageal cancer. Surgery. 1997;122:8–14.CrossRefPubMed
10.
Smithers BM, Gotley DC, Martin I, Thomas JM. Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg. 2007;245:232–40.CrossRefPubMedPubMedCentral
11.
Jarral OA, Purkayastha S, Athanasiou T, Zacharakis E. Should thoracoscopic three-stage esophagectomy be performed in the prone or left lateral decubitus position? Interact Cardiovasc Thorac Surg. 2011;13:60–5.CrossRefPubMed
12.
Tokairin Y, Nagai K, Fujiwara H, Ogo T, Okuda M, Nakajima Y, et al. Mediastinoscopic subaortic and tracheobronchial lymph node dissection with a new cervico-hiatal crossover approach in Thiel-embalmed cadavers. Int Surg. 2015;100:580–8.CrossRefPubMedPubMedCentral
13.
Noguchi T, Shichinohe T, Hirano S, Kondo S. Minimally invasive esophagectomy for cancer patients with low pulmonary function. Hepatogastroenterology. 2010;57(101):768–71.PubMed
14.
Tangoku A, Yoshino S, Abe T, Morita K, Ueno T, Hayashi H, et al. Mediastinoscopy-assisted transhiatal esophagectomy: a safe technique for squamous cell carcinoma of the esophagus. In: Imamura M, editor. Superficial esophageal neoplasm: pathology, diagnosis, and therapy. Tokyo: Springer; 2002. p. 225–35.CrossRef
15.
Hematti H, Mehran RJ. Anatomy of the thoracic duct. Thorac Surg Clin. 2011;21:229–38, ix.
16.
Murakami G, Sato I, Shimada K, Dong C, Kato Y, Imazeki T. Direct lymphatic drainage from the esophagus into the thoracic duct. Surg Radiol Anat. 1994;16:399–407.CrossRefPubMed
17.
Riquet M, Saab M, Le Pimpec Barthes F, Hidden G. Lymphatic drainage of the esophagus in the adult. Surg Radiol Anat. 1993;15:209–11.CrossRefPubMed
18.
Sato T, Sakamoto H. Illustrations and photographs of surgical esophageal anatomy specially prepared for lymph node dissection. In: Color atlas of surgical anatomy for esophageal cancer. Tokyo: Springer; 1992. p. 25–90.
19.
Skandalakis JE, Skandalakis LJ, Skandalakis PN. Anatomy of the lymphatics. Surg Oncol Clin N Am. 2007;16:1–16.CrossRefPubMed
Metadata
Title
Anatomical study of the left superior mediastinal lymphatics for tracheal branches of left recurrent laryngeal nerve-preserving mediastinoscope-assisted surgery in esophageal cancer
Authors
Yutaka Nakajima
Yutaka Tokairin
Yasuaki Nakajima
Kenro Kawada
Kagami Nagai
Kumiko Yamaguchi
Keiichi Akita
Tatsuyuki Kawano
Publication date
01-03-2018
Publisher
Springer Singapore
Published in
Surgery Today / Issue 3/2018
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-017-1600-0

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