Extended Esophagectomy With 3-Field Lymph Node Dissection for Esophageal Cancer

Tachibana, Mitsuo; Kinugasa, Shoichi; Yoshimura, Hiroshi; Dhar, Dipok Kumar; Nagasue, Naofumi

doi:10.1001/archsurg.138.12.1383

Cited by 64 publications

(50 citation statements)

References 62 publications

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“…Thus using hoarseness alone to diagnose RLN palsy will underestimate this complication. A review of three-field lymphadenectomy in Japan yielded an overall RLN palsy rate of 27% (20), some studies have shown up to 60% (1,21). In a recent detailed study on 299 patients, 60% developed RLN palsy, bilateral in 33%, right RLN in 8% and left in 59%.…”

Section: Discussionmentioning

confidence: 99%

Continuous intraoperative vagus nerve stimulation for monitoring of recurrent laryngeal nerve during minimally invasive esophagectomy

Wong¹,

Tong²,

Tsang³

et al. 2017

J. Vis. Surg

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For squamous cell carcinoma of the esophagus, extended mediastinal lymphadenectomy especially around the bilateral recurrent laryngeal nerves (RLN) is associated with high risk of nerve injury.This does not only result in hoarseness of voice, increase the chance of pulmonary complications, but would also affect the quality of life of patients in the long term. Methods to improve safety of lymphadenectomy are desirable. Continuous intraoperative nerve monitoring (CIONM) based on a system using vagus nerve stimulation was tested. In thyroidectomy, this system has been shown to be useful. Our patient cohort was when the electrical signal is picked by an electrode on the endotracheal tune. It detects the amplitude of the electromyography (EMG) of the vocalis muscle as well as its latency of nerve conduction. Reduction in amplitude and increase in latency of the laryngeal EMG signifies imminent injury to the RLN. In thyroidectomy, this system has been shown to be useful (3,4). We describe the adaptation of a commercially available continuous nerve monitoring equipment-NIM 3.0 with APS (Medtronic Inc., Jacksonville, FL, USA) for use in video-assisted thoracoscopic (VATS) minimally invasive esophagectomy (MIE). A pilot study of ten patients has been published recently (5). Patient selection and workupExtended lymphadenectomy is associated with increased morbidity; many surgeons would be selective in its application only in good risk patients. After neoadjuvant chemoradiotherapy, many would also shy away from RLN dissection, especially in the context of VATS esophagectomy. Radiotherapy may result in more fibrosis with obscured tissue planes and it is hard to differentiate cancer infiltration from post radiation fibrosis. In other cases, the tissue may actually become more edematous, easing dissection (6). In the TIME (Traditional Invasive vs. MIE) trial, the primary end-point is difference in pulmonary infection rates between open and MIE. The pulmonary complication rate and the RLN palsy rate were lower in the minimally invasive group while other complications and mortality rates were not significantly different. Bilateral RLN nodal dissection however was not routinely performed (7). Our patients were unselected; the intent was to perform bilateral RLN dissection in a consecutive group of patients. All patients had VATS esophagectomy and 52.5% had had prior chemoradiotherapy. Given the patient population, a higher RLN injury rate may be expected. The incidence of right RLN injury was expectedly to be low, since the nerve is more constant in its position and the area that requires dissection is small. But for the left side, after chemoradiation nearly twice the rate of nerve palsy was found compared to those who had not although the numbers were still small to make this statistically significant. It is the author's experience that after chemoradiation to the superior mediastinum, dissection in the left paratracheal area is more difficult. To strike a balance between striving for cure and increased morbidity, i...

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Section: Discussionmentioning

confidence: 99%

Continuous intraoperative vagus nerve stimulation for monitoring of recurrent laryngeal nerve during minimally invasive esophagectomy

Wong¹,

Tong²,

Tsang³

et al. 2017

J. Vis. Surg

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“…Meanwhile, there's also some series showed the similar surgical outcomes in Table 2 with the 5-year OS rates range from 41.9% to 73.2% (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)51), which is better than the outcome of 2-FL in Table 4 (14,16,(22)(23)(24). The mortality rates maintained between 1.2% and 10.4%, which is lower than that in 2-FL (14,16,(22)(23)(24)(25).…”

Section: Clinical Outcomesmentioning

confidence: 93%

“…Tachibana et al (51) has once reviewed the surgical outcomes of extended esophagectomy with 3-field lymph node dissection after 1980 and made the conclusion that the extended esophagectomy with 3-FL would be a safe treatment with low morbidity and acceptable mortality rates. Meanwhile, there's also some series showed the similar surgical outcomes in Table 2 with the 5-year OS rates range from 41.9% to 73.2% (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)51), which is better than the outcome of 2-FL in Table 4 (14,16,(22)(23)(24).…”

Section: Clinical Outcomesmentioning

confidence: 99%

Three-field lymph node dissection in treating the esophageal cancer

Shang¹,

Chen²,

Hu³

et al. 2016

J. Thorac. Dis.

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There are many controversies in lymphadenectomy for thoracic esophageal cancer, and whether 3-field lymphadenectomy or 2-field lymphadenectomy is better have still been in doubt. The aim of this article is to review the role of the lymph node dissection by introducing the merits and demerits in 3-field lymphadenectomy, and the development in lymphadenectomy's selection, treatment and diagnosis. All the literatures related to esophageal lymphadenectomy and minimally invasive surgery (MIE) were searched in PubMed database and the cross references were added and reviewed to complete the reference list.Several researches elucidated that better overall survival (OS) in patients with esophageal cancer after 3-field lymphadenectomy had been reported worldwide, and 3-field lymphadenectomy is more suitable for treating esophageal cancer with cervical and/or upper mediastinal lymph nodes metastasis than 2-field lymphadenectomy regardless of the tumor's histology and location. Many approaches based on the characteristics of esophageal cancer lymph node metastasis are taken to improve the accuracy of 3-field lymphadenectomy and decrease the postoperative morbidity and mortality, while every approach needs further studies to demonstrate its feasibility. The benefits of the recently rapid-developed techniques performed in treating esophageal cancer: the MIE and the robotic-assisted thoracoscopic esophagectomy are illuminated as well, and both of them are technically safe and feasible for esophageal cancer, whereas further evaluations are still necessary.

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“…El 10% de los tumores de tercio inferior presenta compromiso linfonodal en el tercio torácico superior y el 31% de los de tercio torácico superior presentan compromiso linfonodal perigástrico 29 . En una revisión del año 2003 sobre diferentes trabajos publicados hasta ese momento, se concluyó que la linfadenectomía en 3 campos lograba aumentar la sobrevida y disminuir la recurrencia locoregional, pero debía ser realizada en manos experimentadas 39 . En Chile, un grupo de cirujanos son proclives a efectuar linfadenectomía, juega un rol relevante en el tratamiento del carcinoma espinocelular de esófago pero la evidencia apoya la esofaguectomía subtotal con linfadenectomía en tres campos aún es discutible 12,29 .…”

Section: Linfadenectomía En Cáncer De Esófagounclassified

“…Recientemente hay excelentes reportes dando cuenta de los resultados en cuanto a sobrevida y la tendencia es aceptar que la cirugía mini-invasiva no compromete los resultados oncológicos [65][66][67][68][69] . Desde el advenimiento de la cirugía mínimamen-te invasiva, la adecuada resección oncológica en comparación a la cirugía abierta ha sido cuestionada en relación a los márgenes de resección, la completa linfadenectomía, la correcta etapificación postoperatoria y la sobrevida a largo plazo 37,39 . Todas las resecciones oncológicas potencialmente curativas, requieren de un margen completo de resección del tumor primario R0, siendo éste el factor de mayor importancia en la sobrevida de los pacientes.…”

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Resultados De La Cirugía Actual Para El Tratamiento Del Cáncer De Esófago

et al. 2016

Rev Chil Cir

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surgical treatment of esophageal cancer. an updateEsophageal cancer surgery is a challenge despite the advances in surgical techniques and perioperative care. It continues to have high rates of complications and mortality, even in large volume centers. This paper revises the epidemiology, staging and therapeutic options for esophageal cancer, according to its stage and location. It also encompasses the digestive tract reconstruction options, according to our own experience and reports from abroad.Key words: Esophageal cancer, surgery, digestive tract reconstruction. resumenLa cirugía del cáncer de esófago ha sido y sigue siendo un desafío pese a los avances en técnica quirúrgica y cuidados peri operatorios y a pesar de que las complicaciones postoperatorias y la morbimortalidad sigue siendo alta, aún en centros con alto volumen de procedimientos y más aún en centros no dedicados a la atención de estos pacientes. En este artículo se revisarán algunos aspectos epidemiológicos, las herramientas diagnósticas actuales, su etapificación, y las opciones terapéuticas de acuerdo al estadío, sea en etapas precoces o avanzadas, la localización y tipo de tumor, opciones de reconstrucción del tránsito digestivo en base a lo reportado en la literatura internacional, la experiencia nacional y en base a nuestros propios resultados en

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Extended Esophagectomy With 3-Field Lymph Node Dissection for Esophageal Cancer

Cited by 64 publications

References 62 publications

Continuous intraoperative vagus nerve stimulation for monitoring of recurrent laryngeal nerve during minimally invasive esophagectomy

Continuous intraoperative vagus nerve stimulation for monitoring of recurrent laryngeal nerve during minimally invasive esophagectomy

Three-field lymph node dissection in treating the esophageal cancer

Resultados De La Cirugía Actual Para El Tratamiento Del Cáncer De Esófago

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