Soji Ozawa, MD, PhD, Junya Oguma, MD, PhD, Akihito Kazuno, MD, Miho Nitta, MD, Yamato Ninomiya, MD. Department of Gastroenterological Surgery, Tokai University School of Medicine
INTRODUCTION The purpose of this study was to closely examine the usefulness of the two-tape traction method for traction of the upper esophagus during lymph node dissection (LND) in esophageal cancer patients undergoing thoracoscopic esophagectomy, since LND, especially for the upper mediastinal nodes, was difficult.
PATIENTS AND METHODS We retrospectively reviewed the database of 274 patients with thoracic esophageal cancer who underwent thoracoscopic esophagectomy in the prone position between September 2009 and August 2016. Chronologically, three methods were adopted for traction of the upper esophagus, as follows: Method A (no traction) during the first term; Method B (traction with a single thread) during the second term; Method C (traction with two tapes) during the third term. The number of dissected lymph nodes, the intraoperative factors, and the incidence of adverse events were compared among the three methods using one-way ANOVA, Tukey’s test, Games-Howell’s test or chi-square test.
RESULTS The mean age of the patients was 66.5 years, and there were 223 male and 41 female patients. Method A, Method B and Method C for esophageal traction were applied in 54, 104, and 116 patients, respectively. The mean number of dissected lymph nodes around the right recurrent laryngeal nerve was higher for Method C (3.4) than that for Method A or Method B (2.1, 2.4) (P = 0.001, P < 0.001). The number of dissected nodes around the left recurrent laryngeal nerve was higher for Method C (4.3) than that for Method A or Method B (2.5, 2.7) (P = 0.001, P < 0.001). The number of nodes dissected from the upper mediastinum was higher for Method C (12.9) than that for Method A or Method B (6.9, 8.9) (P < 0.001, P < 0.001). The number of nodes dissected from the chest was higher for Method C (27.7) than that for Method A or Method B (20.3, 22.8) (P < 0.001, P = 0.002). There were no differences in the thoracoscopic time or blood loss during the thoracoscopic procedure among the three methods. There were also no differences in the rate of recurrent laryngeal nerve palsy or postoperative pneumonia either among the three methods.
CONCLUSIONS These results suggested that the two-tape traction method during mediastinal LND was useful as it allowed a stabler and wider operating space to be created, enabling a larger number of lymph nodes to be dissected with no increase in the incidence of thoracoscopy-related adverse events.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80048
Program Number: P407
Presentation Session: Poster (Non CME)
Presentation Type: Poster