190 THE USEFULNESS OF A BILATERAL TRANS-CERVICAL PNEUMOMEDIASTINAL APPROACH FOR MEDIASTINOSCOPIC RADICAL ESOPHAGECTOMY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Yutaka Tokairin ◽  
Yasuaki Nakajima ◽  
Kenro Kawada ◽  
Akihiro Hoshino ◽  
Takuya Okada ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Open Surgery ◽  
Mediastinal Lymph Node ◽  
Recurrent Nerve ◽  
Radical Esophagectomy ◽  
Thoracic Esophageal Cancer ◽  
Thoracoscopic Approach ◽  
Average Total Number ◽  
Tracheobronchial Lymph Nodes ◽  
The Right

Abstract   Several authors have reported on the left trans-cervical and transhiatal approaches under pneumomediastinum and right cervical open surgery for mediastinoscopic esophagectomy. However, with these approaches, sufficient dissection of the right upper mediastinal paraesophageal lymph nodes, right recurrent nerve lymph nodes and the subaortic arch to the left tracheobronchial lymph nodes is thought to be difficult. We herein report the usefulness of the ‘bilateral’ trans-cervical pneumomediastinal approach. Methods Ten patients with thoracic esophageal cancer were treated using this approach. Under pneumomediastinum via a right neck incision, the right cervical and upper mediastinal paraesophageal lymph nodes were dissected. The left recurrent nerve lymph nodes were dissected using a left trans-cervical pneumomediastinal approach. The subaortic arch to the left tracheobronchial lymph nodes was dissected with a combined right and left trans-cervical crossover approach. After this approach, thoracoscopic observation was then performed in the left decubitus position, and if the lymph nodes were not sufficiently dissected, the remnant lymph nodes were retrieved thoracoscopically. Results The average total number of dissected lymph nodes among the right cervical and upper mediastinal paraesophageal lymph nodes identified with a right cervical open/right trans-cervical mediastinoscopic/right thoracoscopic approach was 3.2/4.0/0.6, respectively. The average total number of dissected lymph nodes among the subaortic arch to the left tracheobronchial lymph nodes with a right trans-cervical mediastinoscopic/right thoracoscopic approach was 1.5/0.6, respectively. These findings indicate that, without the right trans-cervical pneumomediastinal approach, roughly four of the right cervical and upper mediastinal paraesophageal lymph nodes and one or two of the subaortic arch to the left tracheobronchial lymph nodes could not have been retrieved. Conclusion A bilateral trans-cervical pneumomediastinal approach is useful for achieving sufficient upper mediastinal lymph node dissection and esophagectomy.

scholarly journals A Mediastinoscopic Approach With Bilateral Cervicopneumomediastinum in Radical Thoracic Esophagectomy

2017 ◽  
Vol 102 (5-6) ◽  
pp. 278-283
Author(s):  
Yutaka Tokairin ◽  
Yasuaki Nakajima ◽  
Kenro Kawada ◽  
Akihiro Hoshino ◽  
Takuya Okada ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Mediastinal Lymph Node ◽  
Bronchial Artery ◽  
Recurrent Nerve ◽  
Open Approach ◽  
Node Dissection ◽  
Radical Esophagectomy ◽  
The Right

We previously reported the performance of “mediastinoscopic esophagectomy with lymph node dissection” (MELD) under pneumomediastinum using a transcervical and transhiatal approach, as a method of radical esophagectomy. The procedure included the dissection of the left tracheobronchial lymph nodes (106tbL). We described our technique for dissecting the upper mediastinal lymph nodes. We revealed that the 106tbL lymph nodes were almost completely retrieved but that the upper thoracic paraesophageal lymph nodes (105) and the right recurrent nerve lymph nodes (106recR) were not completely retrieved. We are therefore of the opinion that a right cervical pneumomediastinal approach is necessary to achieve total dissection. We herein describe a case that was surgically treated using a bilateral cervicopneumomediastinal approach. A 68-year-old male patient was referred to our institution to undergo treatment for lower thoracic esophageal squamous cell carcinoma. The right recurrent nerve was first identified using an open approach. Pneumomediastinum was then initiated to allow for the 105 and 106recR lymph nodes to be completely dissected along the right mediastinal pleura, the right vagus nerve, the proximal portion of the azygos vein, and the right bronchial artery. The left recurrent nerve lymph nodes (106recL) and 106tbL lymph nodes were dissected as described previously. In order to perform bilateral upper mediastinal lymph node dissection and esophagectomy, a bilateral cervicopneumomediastinal approach is needed.

PS01.235: THE METHOD AND THE SHORT OUTCOME OF MEDIASTINAL LYMPH NODES DISSECTION FOR ESOPHAGEAL CANCER USING A TRANS-BICERVICAL AND TRANSHIATAL APPROACH UNDER THE PNEUMOMEDIASTINUM

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 116-116
Author(s):  
Yutaka Tokairin ◽  
Yasuaki Nakajima ◽  
Kenro Kawada ◽  
Akihiro Hoshino ◽  
Takuya Okada ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Recurrent Nerve ◽  
Node Dissection ◽  
Radical Esophagectomy ◽  
Transhiatal Approach ◽  
Cervical Approach ◽  
Thoracic Approach ◽  
The Right

Abstract Background We previously reported the performance of mediastinoscopic esophagectomy with lymph node dissection (MELD) under pneumomediastinum using a transcervical and transhiatal approach as a method of radical esophagectomy. For more complete lymph node dissection, it is necessary to dissect via not only left cervical but also right cervical approach in pneumomediastinum. We herein report the dissection method for upper mediastinum using a cervico-pneumomediastinal approach including right cervical approach in pneumomediastinum and the short surgical outcome. Methods This method was applied to nine cases for esophageal cancer. The right recurrent nerve was first identified using an open approach. Pneumomediastinum was then initiated to allow for the 105 and 106recR lymph nodes to be completely dissected along the right mediastinal pleura, the right vagus nerve, the proximal portion of the azygos vein and the right bronchial artery. The left recurrent nerve (106recL) lymph nodes and 106tbL lymph nodes were dissected using a cross-over technique, as described previously. Results This operation using bilateral cervical approach in pneumomediastinum were performed for nine cases. The median operation time and bleeding is 606 minutes and 506 ml, respectively. The median post-operative stay is 15 days. Conclusion MELD is therefore considered to be a more minimally invasive and useful modality for radical esophagectomy than the thoracic approach, although the field of view is different from that of the thoracic approach. Disclosure All authors have declared no conflicts of interest.

En bloc lymphadenectomy of the right thorax via a uniportal thoracoscopic approach

2020 ◽  
Keyword(s):  
Surgical Technique ◽  
Lymph Nodes ◽  
Surgical Instruments ◽  
Malignant Cells ◽  
En Bloc ◽  
Thoracoscopic Approach ◽  
Video Tutorial ◽  
The Right ◽  
Taking Care

The uniportal approach to an en bloc complete lymphadenectomy is significantly more challenging than a multiportal approach or a thoracotomy because of the limited angulation available to the surgeon and the limited number of usable surgical instruments. Because of these limitations, it is very important to completely master the specific surgical steps in order to achieve success. Additionally, it is important to make sure the lymph nodes remain structurally intact, taking care not to cause damage by grasping them during lymphadenectomy, in order to prevent the dissemination of malignant cells into the thorax. In this video tutorial, we demonstrate our surgical technique for lymphadenectomy in the right upper (2R/4R) or lower (7/8/9) mediastinal zone, which is suitable for a uniportal approach, and explain the nuances of performing it.

scholarly journals Immunotherapy-Induced Sarcoid-Like Reaction: A Shrewd Imitator

2021 ◽  
Vol 9 ◽  
pp. 232470962110094
Author(s):  
Hassaan Yasin ◽  
Vivek Yadala ◽  
Noman Ahmed Jang Khan ◽  
Vincent Graffeo ◽  
Krista Denning ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Lymph Nodes ◽  
Mediastinal Lymph Node ◽  
Mek Inhibitor ◽  
Needle Aspiration ◽  
Neck Mass ◽  
Emission Tomography ◽  
Mediastinal Lymph Nodes ◽  
Positron Emission ◽  
The Right

A 40-year-old male with a right-sided neck mass was diagnosed with metastatic melanoma. A repeat positron-emission tomography after treatment with combination immunotherapy demonstrated increased hypermetabolic activity in the right supraclavicular, hilar, and mediastinal regions. Immunotherapy was discontinued and a BRAF/MEK inhibitor combination was started. Repeat imaging showed a decrease in size of the neck mass; however, hilar and mediastinal lymph nodes increased in size. A fine needle aspiration of mediastinal lymph nodes was consistent with a granulomatous process. A diagnosis of a sarcoid-like reaction (SLR) was made, and he was started on steroids. A follow-up positron emission tomography showed decreased hilar and mediastinal lymph node hypermetabolic activity. We, therefore, report this rare case of immunotherapy-induced SLR to the expanding literature on immunotherapy-related adverse effects and would like to highlight that SLR can occur in conjunction with disease progression making it challenging to distinguish between the two.

Salvage surgery for lung cancer with tracheo-oesophageal fistula during concurrent chemoradiotherapy

2019 ◽  
Vol 29 (4) ◽  
pp. 641-643
Author(s):  
Isamu Watanabe ◽  
Kazuya Takamochi ◽  
Shiaki Oh ◽  
Kenji Suzuki
Keyword(s):  
Lung Cancer ◽  
Concurrent Chemoradiotherapy ◽  
Salvage Surgery ◽  
Mediastinal Lymph Node ◽  
Advanced Lung Cancer ◽  
Recurrent Nerve ◽  
Recurrent Nerve Palsy ◽  
Initial Surgery ◽  
The Right ◽  
Staged Reconstruction

Abstract A 48-year-old man presenting with cough, dysphagia and chest pain was diagnosed with advanced inoperable squamous cell carcinoma located in the right S2 with mediastinal lymph node metastases invading the oesophagus (c-T4N2M0 stage IIIB). Concurrent chemoradiotherapy (66 Gy) was planned, but he developed a tracheo-oesophageal fistula during the chemoradiotherapy course (26 Gy). A right sleeve pneumonectomy with oesophagectomy, cervical oesophagostomy and enterostomy were performed. Although bilateral recurrent nerve palsy occurred, he recovered via enhanced rehabilitation and was discharged 28 days after the salvage surgery. Three months after the initial surgery, staged reconstruction surgery of the stomach was performed. Intensive rehabilitation resulted in restored swallowing ability. He is alive with recurrent disease 12 months after surgery. This is the first report of salvage surgery for advanced lung cancer with tracheo-oesophageal fistula during concurrent chemoradiotherapy.

Pulmonary Thromboembolism Associated With Blastomyces dermatitidis in a Dog

2002 ◽  
Vol 38 (5) ◽  
pp. 425-430 ◽  
Author(s):  
Nancy C. McGuire ◽  
Allison Vitsky ◽  
Curt M. Daly ◽  
Melissa J. Behr
Keyword(s):  
Lymph Nodes ◽  
Bronchoalveolar Lavage Fluid ◽  
Pulmonary Thromboembolism ◽  
Lavage Fluid ◽  
Surgical Removal ◽  
Extensive Literature ◽  
Lung Lobe ◽  
Extensive Literature Search ◽  
Tracheobronchial Lymph Nodes ◽  
The Right

An 8-year-old, male castrated golden retriever presented for cough and increased respiratory effort. Radiographs revealed an alveolar pattern in the right caudal lung lobe and an opacity at the carina suspected to be enlarged tracheobronchial lymph nodes. The disease progressed to involve the right middle lung lobe. Cytopathology of a fine-needle aspirate and bronchoalveolar lavage fluid were nondiagnostic. Surgical removal of the right caudal lung lobe and biopsy of the perihilar lymph nodes revealed pulmonary thromboembolism and reactive lymph nodes. The dog died several days postoperatively, and necropsy revealed diffuse pulmonary thromboembolism. Additionally, Blastomyces dermatitis organisms were identified in a pyogranulomatous mass surrounding the trachea near the carina. In an extensive literature search, no reports of pulmonary thromboembolism associated with blastomycosis were identified. It is suspected that the inflammation secondary to blastomycosis caused the thromboembolism.

New Technique of Lymphadenectomy along Left Recurrent Nerve for Thoracic Esophageal Cancer

2013 ◽  
Vol 64 (2) ◽  
pp. 113-113
Author(s):  
E. Nagai ◽  
K. Nakata ◽  
K. Ohuchida ◽  
R. Maeyama ◽  
S. Shimizu ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
New Technique ◽  
Recurrent Nerve ◽  
Thoracic Esophageal Cancer
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