Left recurrent nerve lymph node dissection in robotic esophagectomy for esophageal cancer without esophageal traction

Abstract

Background Because the robotic arm is located on the dorsal side of the patient, when the esophagus is pulled dorsally for the left recurrent nerve lymph node (LRLN) dissection, the robotic arm interferes with the surgical field. This made it difficult to prepare for the left recurrent lymph node dissection. We developed LRLN dissection in robotic surgery with natural space creation by physiological organ movement and evaluated the short-term results. Methods In this retrospective study, we analyzed 102 cases of robot-assisted thoracoscopic subtotal esophagectomy (RATE) among radical subtotal esophagectomies performed between December 2018 and December 2022 using medical records. LRLN dissection is preceded by a dissection of the esophagus from the trachea. Leaving the esophagus on the vertebral side and away from the trachea resulted in a physiological elevation of the esophagus, providing space between the trachea and esophagus. Results The thoracic surgery time in RATE was 181 (115–394) min. The number of LRLNs dissected was 4 (1–14). Six patients (6%) had a postoperative recurrence in the mediastinal lymph nodes. Seven patients (7%) had grade ≥ 1 left recurrent nerve palsy. Conclusions LRLN dissection with RATE using natural space creation was performed safely with a sufficient number of dissected lymph nodes and little left recurrent nerve palsy.

Usefulness of Perioperative Nutritional Therapy with the Glutamine/Arginine/Calcium β-Hydroxy-β-Methylbutyrate Product in Esophageal Cancer Surgery: A Single-Center Retrospective Study

“…Various efforts to prevent complications during the perioperative period of patients receiving esophageal cancer surgery have been reported. The use of intraoperative nerve monitoring and ingenuity in mediastinal lymph node dissection are useful to prevent recurrent laryngeal nerve paralysis, and these approaches also resulted in a reduction in the incidence of aspiration pneumonia, respiratory failure, and sputum expectoration disorders [15,16]. Additionally, the development of preoperative risk assessment based on the patient's nutritional status and background diseases, intraoperative evaluation of the blood flow of the reconstructed organs using indocyanine green, and strict blood sugar management in diabetic patients have been reported to be useful in preventing the development anastomotic leakage [1,[17][18][19][20].…”