Linfadenectomía mediastinal para el cáncer de esófago mediante un abordaje miniinvasivo. Diferencias entre en el adenocarcinoma y el carcinoma escamoso

Abstract

Background. In the multimodal treatment era, surgery remains the mainstay for oesophageal cancer. The type of lymphadenectomy raises important controversies between eastern and western countries, mainly due to the lack of consensus on its extension. Objectives. Analyse the type of mediastinal lymphadenectomy performed for adenocarcinoma and squamous cells carcinoma, of a group of patients who underwent a prone position minimally invasive esophagectomy. Material and methods. From November 2011 to August 2019, 51 patients were treated for potentially curable oesophageal cancer who underwent minimally invasive esophagectomy with two-field lymphadenectomy (mediastinal and abdominal). Based on the histological type and location of the tumour, the different types of lymph nodes dissection were performed. Results. The median of nodes obtained for Adenocarcinoma was 5.0 (3-16) while for squamous cells carcinoma cases it was 8.0 (4-38) (p = 0.019). Two intraoperative complications were recorded: a lesion of the left source bronchus during sub carinal lymphadenectomy, and injury to the right recurrent nerve during an extended lymphadenectomy. Conclusion. We can conclude the mediastinal lymphadenectomy is a feasible procedure to perform with a minimally invasive approach in prone position, for offering an adequate visualization of the anatomical structures and obtaining an acceptable number of nodes. However, it is subject to complications, some of which could be serious.