Lymph node dissection and recurrent laryngeal nerve protection in minimally invasive esophagectomy

Wang, Zhen; Mao, Yousheng; Gao, Shugeng; Li, Yin; Tan, Lijie; Daiko, Hiroyuki; Liu, Shuoyan; Chen, Chun; Koyanagi, Kazuo; He, Jie

doi:10.1111/nyas.14427

Cited by 22 publications

(19 citation statements)

References 77 publications

(105 reference statements)

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“…Of these, 12 studies which did not compare IONM with non-IONM (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). Three case reports on IONM (35)(36)(37), one letter to the editor (38), and two reviews (39,40) were excluded. Additionally, four meeting abstracts lacking full texts (41)(42)(43)(44), two studies which utilized data from the same study (45,46), and two studies which were not in English (47,48) were excluded.…”

Section: Search Resultsmentioning

confidence: 99%

Efficacy of Intraoperative Recurrent Laryngeal Nerve Monitoring During Thoracoscopic Esophagectomy for Esophageal Cancer: A Systematic Review and Meta-Analysis

Wang

Guo

et al. 2021

Front. Surg.

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Background: Recurrent laryngeal nerve paralysis (RLNP), a severe complication of mini-invasive esophagectomy, usually occurs during lymphadenectomy adjacent to recurrent laryngeal nerve. This systematic review and meta-analysis aimed to evaluate the efficacy of intraoperative nerve monitoring (IONM) in reducing RLNP incidence during mini-invasive esophagectomy.Methods: Systematic literature search of PubMed, EMBASE, EBSCO, Web of Knowledge, and Cochrane Library until June 4, 2021 was performed using the terms “(nerve monitoring) OR neuromonitoring OR neural monitoring OR recurrent laryngeal nerve AND (esophagectomy OR esophageal).” Primary outcome was postoperative RLNP incidence. Secondary outcomes were sensitivity, specificity, and positive and negative predictive values for IONM; complications after esophagectomy; number of dissected lymph nodes; operation time; and length of hospital stay.Results: Among 2,330 studies, five studies comprising 509 patients were eligible for final analysis. The RLNP incidence was significantly lower (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.12–0.88, p < 0.05), the number of dissected mediastinal lymph nodes was significantly higher (mean difference 4.30, 95%CI 2.75–5.85, p < 0.001), and the rate of hoarseness was significantly lower (OR 0.14, 95%CI 0.03–0.63, p = 0.01) in the IONM group than in the non-IONM group. The rates of aspiration (OR 0.31, 95%CI 0.06–1.64, p = 0.17), pneumonia (OR 1.08, 95%CI 0.70–1.67, p = 0.71), and operation time (mean difference 7.68, 95%CI −23.60–38.95, p = 0.63) were not significantly different between the two groups. The mean sensitivity, specificity, and positive and negative predictive values for IONM were 53.2% (0–66.7%), 93.7% (54.8–100%), 71.4% (0–100%), and 87.1% (68.0–96.6%), respectively.Conclusion: IONM was a feasible and effective approach to minimize RLNP, improve lymphadenectomy, and reduce hoarseness after thoracoscopic esophagectomy for esophageal cancer, although IONM did not provide significant benefit in reducing aspiration, pneumonia, operation time, and length of hospital stay.

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Section: Search Resultsmentioning

confidence: 99%

Efficacy of Intraoperative Recurrent Laryngeal Nerve Monitoring During Thoracoscopic Esophagectomy for Esophageal Cancer: A Systematic Review and Meta-Analysis

Wang

Guo

et al. 2021

Front. Surg.

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“…The surgeons could use one silk that was punctured out in the fifth intercostal space of the scapular inner edge to suspend the esophagus and then dissect the left RLN lymph nodes and the thoracic esophagus easily. This method not only reduces the probability of injury to the left RLN, but also increases the number of left RLN lymph nodes removed, which is corrected closely with the patient's health, pathological staging and prognosis (17). Zhang (18) et al…”

Section: Discussionmentioning

confidence: 99%

Two-rope method for dissecting esophagus in McKeown MIE

Wang

Liu²,

Zhang³

et al. 2023

Front. Surg.

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ObjectiveMinimally invasive McKeown esophagectomy (McKeown MIE) is performed at many hospitals in esophageal cancer(EC) treatment. However, secure and quick methods for dissecting the esophagus and dissecting lymph nodes in this surgery are lacking. This study introduces a simple, secure and feasible esophagus dissecting technique named two-rope method. Two mobile traction ropes are placed around the esophagus and we tow these ropes to free the esophagus, dissect the lymph nodes, and decrease the operative trauma.Materials and MethodsRetrospective analysis was performed on 112 patients who underwent McKeown MIE in our center from January 2019 to September 2021. They were assigned into two groups based on the method of dissecting the esophagus: Group A (two-rope method, 45 cases) and Group B (regular method, 67 cases). Operation time, thoracic operation time, the number of dissected thoracic lymph nodes, and postoperative complications were compared between the two groups after propensity score matching.ResultsUsing 1:1 nearest neighbor matching, we successfully matched 41 pairs of patients. Operation time, thoracic operation time, and the duration (ac to as) was significantly shorter and the size of the abdominal incision was significantly smaller in the Group A than Group B (p < 0.05). There was no statistically significant difference in the number of dissected thoracic lymph nodes, pulmonary infection, anastomotic leak, recurrent laryngeal (RLN) injury, and chylothorax between the two groups (p > 0.05).ConclusionsTwo-rope method to free the esophagus and dissect thoracic lymph nodes in McKeown MIE has significant advantages compared with the regular method. The technique is, therefore suitable for widespread adoption by surgeons.

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“…7 Therefore, the lymph nodes in the lesion area should be thoroughly dissected as far as possible during esophagectomy, in addition to resecting the cancerous esophagus with sufficient length. [8][9][10] Standard 2FLND, including midinferior mediastinal and abdominal lymph nodes, is commonly used by many domestic scholars.…”

Section: Discussionmentioning

confidence: 99%

Effects of standard and total two-field lymph node dissection on prognosis of patients undergoing Esophagectomy

Guo¹,

Li²,

Wang³

et al. 2022

Pak J Med Sci

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Objectives: To investigate the effects of standard two-field lymph node dissection (2FLND) and total 2FLND on the short-term and long-term clinical efficacy and complications of patients undergoing esophagectomy. Methods: The clinical data of 268 patients undergoing radical Ivor-Lewis esophagectomy in our hospital from January 2008 to November 2015 were analyzed retrospectively. According to different methods of lymph node dissection (LND), the patients were divided into standard 2FLND group (n = 121) and total 2FLND group (n = 147). The LND status, postoperative complications, survival rate and lymph node recurrence of the two groups were analyzed. Results: Lymph node metastasis rate showed no statistically significant difference between the standard 2FLND group and the total 2FLND group (71.1% and 63.3%, respectively, P > 0.05). The incidence of postoperative complications was 5.8% (7/121) in the standard 2FLND group, which was lower than that in the total 2FLND group [17.0% (25/147)], with a statistically significant difference (χ2 = 7.948, P < 0.01). The 5-year survival rate of the standard 2FLND group and the total 2FLND group was 29.8% and 28.6%, respectively, without statistically significant difference (χ2 = 0.005, P > 0.05). The lymph node recurrence rate in the standard 2FLND group was 41.3% (50/121), which was higher than 19.0% (28/147) of the total 2FLND group (χ2 = 15.959, P < 0.01). Conclusion: Compared with standard 2FLND, total 2FLND does not improve the postoperative survival of patients with esophageal carcinoma, and the risk of complications is higher. doi: https://doi.org/10.12669/pjms.38.4.4031 How to cite this:Guo Q, Li H, Wang H, Zhang D, Li Y. Effects of standard and total two-field lymph node dissection on prognosis of patients undergoing Esophagectomy. Pak J Med Sci. 2022;38(4):---------. doi: https://doi.org/10.12669/pjms.38.4.4031 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Lymph node dissection and recurrent laryngeal nerve protection in minimally invasive esophagectomy

Cited by 22 publications

References 77 publications

Efficacy of Intraoperative Recurrent Laryngeal Nerve Monitoring During Thoracoscopic Esophagectomy for Esophageal Cancer: A Systematic Review and Meta-Analysis

Efficacy of Intraoperative Recurrent Laryngeal Nerve Monitoring During Thoracoscopic Esophagectomy for Esophageal Cancer: A Systematic Review and Meta-Analysis

Two-rope method for dissecting esophagus in McKeown MIE

Effects of standard and total two-field lymph node dissection on prognosis of patients undergoing Esophagectomy

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