Yusuke Taniyama, Tadashi Sakurai, Takahiro Heishi, Chiaki Sato, Hiroshi Okamoto, Kai Takaya, Takeshi Naito, Michiaki Unno, Takashi Kamei. Tohoku University, Department of Surgery
Background: Lymph node (LN) dissection around recurrent laryngeal nerve (RLN) is one of the most important and difficult procedure in esophageal cancer surgery because of high rate of LN metastasis and risk of RLN palsy. Especially around left RLN, the surgical area is far and narrow by thoracic approach which tends to results in insufficient LN dissection. Therefore, we tried to remove this LN by imaging lymphatic chain to dissect sufficient LN.
Surgical Procedure: We perform thoracoscopic esophagectomy by semi-prone position using 6-10mmHg thoracic air pressure. After dissection of right RLN LN, middle and lower esophagus, encircle the esophagus at the level of bifurcation of bronchus and pull toward right side by tape to dissect the dorsal and left side of upper esophagus. Dissect the tissue including left RLN LN from trachea by pulling esophagus up to dorsal side and try to move this tissue toward dorsal side of left RLN so that this RLN LN tissue can recognize as the “lymphatic chain”. To increase the mobility of esophagus, cut the esophagus at the level of aortic arch and pull further up this upper esophagus to dorsal side. Cut the esophageal branch of RLN and separate this lymphatic chain from RLN. At the end of thoracic procedure, this lymphatic chain is attached to upper esophagus. After the upper esophagus has pulled out from cervical site, lymphatic chain can easily recognize at the esophageal wall.
Result: We performed this lymphatic chain procedure in 88 cases. To evaluate this procedure, 106 cases of conventional method by same prone positioned esophagectomy was used for control. There was no statistical difference between these two groups in amount of blood loss (lymphatic chain: conventional = 45ml: 55ml, p=0.524), rate of RLN palsy (14.8% : 14.2%, p=1.00). Although the thoracic operation time was extended in some degree (291min : 270min, p=0.005), number of dissected LN was increased (2.9 : 1.9, p=0.004) and recurrence along left RLN has been relatively fewer by this method (4.5% : 7.5% p=0.552).
Conclusion: LN dissection around left RLN would be easy and sufficient by imaging lymphatic chain. Further improvement is needed to secure this procedure and further evaluation should be done to support this data.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 85471
Program Number: P725
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster