Minimally invasive oesophagectomy with extended lymph node dissection and thoracic duct resection for early-stage oesophageal squamous cell carcinoma

Abstract

Background: Oesophageal squamous cell carcinoma is an aggressive disease owing to early and widespread lymph node metastases. Multimodal therapy and radical surgery may improve prognosis. Few studies have investigated the efficacy of radical lymph node and thoracic duct resection. Methods: Patients with oesophageal squamous cell carcinoma who underwent transthoracic minimally invasive oesophagectomy (TMIE) for cancer at Keio University Hospital betweenJanuary 2004 and December 2016 were selected. Between 2004 and 2008, TMIE was performed in the lateral decubitus position without thoracic duct resection (standard TMIE). From 2009 onwards, TMIE with extended lymph node and thoracic duct resection was introduced (extended TMIE). Demographics, co-morbidity, number of retrieved lymph nodes, pathology, postoperative complications and recurrence-free survival (RFS) were compared between groups. Results: Forty-four patients underwent standard TMIE and 191 extended TMIE. There were no significant differences in clinical and pathological tumour stage or postoperative complications. The extended-TMIE group had more lymph nodes removed at nodal stations 106recL and 112. Among patients with cT1 N0 disease, RFS was better in the extended-TMIE group (P < 0⋅001), whereas there was no difference in RFS between groups in patients with advanced disease. Conclusion: Extended TMIE including thoracic duct resection increased the number of lymph nodes retrieved and was associated with improved survival in patients with cT1 N0 oesophageal squamous cell carcinoma.

Prognostic impact of thoracic duct lymph node metastasis in esophageal squamous cell carcinoma

“…Especially in terms of the definition of TDLN-Ut, dissecting the plane including the sympathetic nerve, the left pleura and the aortic arch are identified in the upper mediastinum in the dorsal mobilization of the esophagus as introduced in the surgical procedure in a previous report. 11 Therefore, the TD and all the surrounding lymphatic/connective tissues are to be mobilized together. The plane, which included the sympathetic nerve behind the left recurrent laryngeal nerve, TD, and other lymphatic/connective tissues, were dissected after the lymphadenectomy surrounding left recurrent laryngeal nerve was done.…”

Effect of Prophylactic Ligation of the Thoracic Duct on Long-Term Survival in Patients Undergoing Esophagectomy: A Meta-Analysis

“…Tao (23) reported that PLG is a safe and effective method to reduce post-operative chylothorax. Both Satoru (22) and Matsuda (17) concluded that ligation has a superior effect on long-term prognosis.…”

Effect of Postoperative Oral Intake Status on Sarcopenia Six Months After Esophageal Cancer Surgery

“…The majority (85.7%) of patients who aspirated thickened liquids showed silent aspiration without a cough re ex, that is, categorized into PAS 8. The time to start oral intake, the time to nish diet modi cation (i.e., acquisition of regular food), and the date of discharge were POD 13 (IQR, 9-18), 20 (IQR, [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29], and 26 (IQR, 21-40), respectively, signi cantly longer in the NOI group than in the OI group (p<0.001). On the other hand, the incidence of oral intake-related complication (i.e., aspiration pneumonia) was not signi cantly different between the NOI and OI groups from the initiation of oral intake until the time of discharge (10.9% vs. 5.7%, p=0.226).…”