Value of subcarinal lymph node dissection in esophageal cancer surgery: A case-control study

Abstract

We investigated the value of subcarinal lymph node dissection in esophageal cancer surgery. Altogether, 240 patients with esophageal cancer admitted to our department between June 2012 and January 2016 were prospectively assigned to an experimental group (subcarinal lymph node dissection group, n = 120 cases) and a control group (uncleaned group, n = 120 cases). The number of subcarinal lymph nodes and the rate of subcarinal lymph node metastasis were determined, and the factors influencing subcarinal lymph node metastasis were analyzed using logistic regression in the experimental group. The operation time, postoperative complications, intraoperative blood loss, postoperative hospital stay, total postoperative hospital cost, and 5-year survival rate were compared between the 2 groups. In the experimental group, an average of 6.03 subcarinal lymph nodes were dissected, and the lymph node metastasis rate was 18.33%. The subcarinal lymph node metastasis rate in the experimental group was related to the size of the subcarinal lymph nodes, depth of tumor invasion, and tumor location. The 5-year survival rate was higher in the experimental group than in the control group (44.2% vs 30.0%, χ 2 = 6.407, P = .04). The subcarinal lymph node metastasis rate in patients with esophageal cancer is high. Patients with mid-thoracic esophageal cancers that infiltrate beyond the esophageal muscle layer with subcarinal lymph node size > 1.0 cm should undergo lymph node resection, despite increased operation time, incidence of postoperative pulmonary infection, hospitalization time, and total postoperative cost; lymph node resection may improve the 5-year survival rate.

Application of Inflatable Video-Assisted Mediastinoscopic Transhiatal Esophagectomy in Individualized Treatment of Esophageal Cancer

“…Existing guidelines advocate complete lymph node dissection to achieve more accurate lymph node staging and better long-term prognosis [40,41]. However, the mediastinal approach has received criticism for incomplete lymph node dissection and is only used for mediastinal lymph node biopsies and in early-stage (stage N0) patients who cannot tolerate one-lung ventilation.…”

“…Using a right neck incision, in addition to a single left neck incision, not only increases the effectiveness of lymph node dissection near the right RLN but also circumvents the blockage caused by the aortic arch, minimizes the arrow effect, and allows for better visualization of the lymph nodes from the aortic arch to the left tracheobronchial nerve [41]. Simultaneously, it requires additional instruments for traction, and performing traction of the trachea ventrally facilitates lymph node exposure and thorough lymph node dissection [45,46].…”