Thoracoscopic radical esophagectomy combined with left inferior pulmonary ligament lymphadenectomy for esophageal carcinoma via the right thoracic approach

Abstract

To evaluate the necessity, safety, and feasibility of left inferior pulmonary ligament lymphadenectomy during video-assisted thoracic surgery (VATS) radical esophagectomy via the right thoracic approach. Thirty patients (20 men, 10 women) with thoracic esophageal squamous cell carcinoma (ESCC) were recruited for this study. The patients’ age ranged from 50 to 80 years, with an average age of 66.17 ± 7.47 years. After the patients underwent VATS radical esophagectomy and left inferior pulmonary ligament lymph node dissection (LIPLND) via the right thoracic approach, the operative outcomes included operative time, length of hospital stay, postoperative complications, number of lymph nodes removed, and postoperative pathologic results were evaluated. There were no massive hemorrhages of the left inferior pulmonary vein during the operation. The operative time of LIPLND was 8.67 ± 2.04 minutes, and the length of postoperative hospital stay was 12.23 ± 2.36 days. The postoperative complications included 2 cases of left pneumothorax, 4 pulmonary infection cases, and no chylothorax. Moreover, 68 LIPLNs were dissected, 5 of which were positive, and the degree of metastasis was 7.4%. The postoperative pathologic results showed that 3 cases of LIPLNs were positive, with a metastasis rate of 10.0%. Among them, 2 cases were SCC of the lower thoracic esophagus, and 1 case was SCC of the middle thoracic esophagus, which involved the lower segment. Thoracoscopic esophagectomy combined with left inferior pulmonary ligament lymphadenectomy for esophageal carcinoma via the right thoracic approach will not increase the difficulty of operation, increase the incidence of postoperative complications or prolong the postoperative hospital stay, and can theoretically reduce tumor recurrence. Therefore, we believe that LIPLND is necessary, safe, and feasible and is worthy of clinical popularization and application.

A comparative study on the clinical efficacy of inflatable mediastinoscopy syncrhonized laparoscopic esophagectomy with McKeown's technique

“…Esophageal cancer is a prevalent malignancy that is observed globally, and within China, esophageal squamous cell carcinoma is particularly common, mostly associated with an unfavorable prognosis 1 .At present, surgery remains the primary therapeutic approach, particularly for patients in the initial and intermediate phases, which can achieve the purpose of radical treatment 2 .At present, surgery remains the primary therapeutic approach, particularly for patients in the initial and intermediate phases, which can achieve the purpose of radical treatment 3 .The evolution of surgical techniques for esophageal cancer resection has progressed from the initial left thoracotomy with a large incision using the Sweet technique, to the adoption of the Ivor-Lewis technique involving a right thoracotomy and abdominal double incision.…”