Intraoperative ultrasonography for the identification of thoracic recurrent laryngeal nerve lymph nodes in patients with esophageal cancer

Abstract

The rate of vocal cord palsy following resection for esophageal carcinoma has increased due to lymphadenectomy around the recurrent laryngeal nerves (RLN). The aim of this pilot study was to assess the ability of intraoperative ultrasonography to detect thoracic RLN node metastases in patients with esophageal cancer. Intraoperative ultrasonography was performed during esophagectomy to assess whether RLN lymph nodes were metastatic in 10 patients with esophageal squamous cell cancer. All patients underwent RLN lymphadenectomy, and the nodes were assessed for metastasis. Three patients had pathological RLN lymph node metastases, of which one had right RLN node metastasis, and three had left RLN node metastases. For detecting right RLN lymph node metastasis, the sensitivity, specificity, and positive and negative predictive values of intraoperative ultrasonography were 100%, 33.3%, 14.3%, and 100%, respectively. For the detection of left RLN lymph node, these values were 100%, 85.7%, 75%, and 100%, respectively. This study suggests that intraoperative ultrasonography is feasible and safe to detect RLN lymph node metastases for patients with esophageal cancer. Further study will be performed to evaluate the validity and utility of this diagnostic technique.

Recurrent laryngeal nerve lymph node dissection may not be suitable for all early stage esophageal squamous cell carcinoma patients: an 8-year experience

“…There was no high-level or some low-level evidences showed that RLNLN dissection influenced the prognosis of esophageal carcinoma (27). Many reports have showed that significant postoperative morbidity and mortality are associated with RLNLN dissection (28).…”

Diagnostic value of intraoperative ultrasonography in assessing thoracic recurrent laryngeal nerve lymph nodes in patients with esophageal cancer

“…The details of the procedure are described in a previous report [ 5 ]. Firstly, the right RLN region was detected between esophagus and the right SCA (subclavicular artery) (Fig.…”

“…In a preliminary report [ 5 ], it was suggested that intraoperative ultrasonography (IU) was safe and feasible when used for the detection of RLN lymph nodes metastases in patients with thoracic esophageal cancer. The purpose of this study was to evaluate the ability of IU to detect RLN nodal metastases in esophageal cancer patients.…”

Short and Long-Term Outcomes of Epidural or Intravenous Analgesia after Esophagectomy: A Propensity-Matched Cohort Study

“…Tumors were staged according to the 7th edition of the AJCC staging system[ 11 ]. The Mckeown-type procedure was described previously[ 10 , 12 ]: first involved esophageal mobilization and radical mediastinal lymphadectomy through right thoracotomy or thoracoscopy, and then laparotomy or laparoscopic gastric mobilization. A gastric tube is fashioned with a width of approximately 4–5 cm, and pulled through retrosternal or posterior mediastinal routes to the left neck.…”

“…The preoperative workup regularly included physical examination, complete blood cell count, serum biochemistry tests, computed tomography, endoscopic ultrasonography, pulmonary function test and histological diagnosis. Surgical techniques have been described previously[ 12 ]. Normally, blood cell count, serum biochemistry tests were performed in postoperative day (POD) 1, 3 and 7, and temperature, heart rate and blood pressure were measured at 7 a.m. everyday.…”