PS01.237: SAFETY OF RECURRENT LARYNGEAL NERVE NODAL DISSECTION IN PATIENTS WITH ESOPHAGEAL CANCER WHO HAD UNDERGONE CHEMORADIOTHERAPY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 117-117
Author(s):  
Yin-Kai Chao ◽  
Ivan De Leon Ayala
Keyword(s):  
Esophageal Cancer ◽  
Learning Curve ◽  
Recurrent Laryngeal Nerve ◽  
Conflicts Of Interest ◽  
Perioperative Complications ◽  
Group Versus ◽  
Laryngeal Nerve ◽  
The Us ◽  
Technical Challenges ◽  
Cusum Method

Abstract Background Lymph node dissection (LND) along the recurrent laryngeal nerve (RLN) is a challenging surgical procedure that carries a high risk of morbidity, especially in patients who had undergone chemoradiotherapy (CRT). Here, we retrospectively examined the feasibility and safety of thoracoscopic RLN LND in patients with esophageal cancer who had been previously treated with CRT. Methods Patients with esophageal cancer who had undergone thoracoscopic esophagectomy with RLN LND were divided into two groups according to prior treatment with CRT or not (CRT group versus upfront surgery [US] group, respectively). Intergroup comparisons were made in terms of 1) number of dissected nodes, 2) rates of RLN palsy, and 3) rates of perioperative complications. The learning curve for the RLN LND procedure was investigated with the cumulative sum (CUSUM) method. Results A total of 103 patients with esophageal cancer were included in the study (CRT group: n = 65; US group: n = 38). No conversion to open thoracotomy was required in either group. Moreover, intraoperative blood loss and the need for blood transfusions were similar. The technical challenges of RLN LND after CRT were more evident when performed in the left side. Accordingly, complete skeletonization of the left RLN was achieved only for 66.2% of patients in the CRT group, a percentage significantly lower than that obtained in the US group (86.8%; P = 0.022). Similarly, the rate of postoperative RLN palsy in the left side was significantly higher in the CRT group than in the US group (32.6% vs. 9.1%, respectively, P = 0.015), albeit not resulting in higher pneumonia rates. CUSUM analysis revealed a steep learning curve for left RLN LND performed in patients who had undergone CRT. Significant fluctuations in RLN palsy rates were observed over time, suggesting that proficiency did not improve linearly with increasing surgical experience. Conclusion To our knowledge, this is the first study to specifically investigate the feasibility and safety of thoracoscopic RLN LND in patients with esophageal cancer who had undergone CRT. Our data indicate that RLN LND is feasible even after CRT, although the technical challenges to be faced are greater than in CRT-naïve patients. Disclosure All authors have declared no conflicts of interest.

VS01.04: RELIABLE SURGICAL TECHNIQUES FOR LYMPHADENECTOMY ALONG THE LEFT RECURRENT LARYNGEAL NERVE DURING THORACOSCOPIC ESOPHAGECTOMY IN THE PRONE POSITION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 44-44
Author(s):  
Taro Oshikiri ◽  
Tetsu Nakamura ◽  
Hiroshi Hasegawa ◽  
Masashi Yamamoto ◽  
Shingo Kanaji ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Recurrent Laryngeal Nerve ◽  
Prone Position ◽  
Conflicts Of Interest ◽  
Surgical Techniques ◽  
Laryngeal Nerve ◽  
Thoracoscopic Esophagectomy ◽  
Left Recurrent Laryngeal Nerve

Abstract Description Background Lymphadenectomy along the left recurrent laryngeal nerve (RLN) in esophageal cancer is important for disease control but requires advanced dissection skills. Complete dissection of the lymph nodes along the left RLN in a safe manner is important. We demonstrate the reliable method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the prone position (TEP). Methods This procedure is performed for all of resectable thoracic esophageal cancers. The essence of this method is to recognize the lateral pedicle as a two-dimensional membrane that inclu replicatedes the left RLN, lymph nodes around the nerve, and primary esophageal arteries. By drawing the proximal portion of the divided esophagus and the lateral pedicle, identification and reliable cutting of the primary esophageal arteries and distinguishing the left RLN from the lymph nodes are simplified. Results We performed 46 TEPs for esophageal cancer using this method with no conversion to an open procedure in 2015 at Kobe University. No intraoperative morbidity related to the left RLN was observed. The mean number of harvested lymph nodes along the left RLN was 6.9 ± 4.2. Left RLN palsy greater than Clavien-Dindo classification grade II occurred in 4 patients (8%), all of them were reversible. The incidence of lymph node metastasis along the left RLN was 22%. Conclusion Our method for lymphadenectomy along the left RLN during TEP is safe and reliable. It has a low incidence of left RLN palsy and provides sufficient lymph node dissection along the left RLN. Disclosure All authors have declared no conflicts of interest.

RA07.05: DIAGNOSTIC VALUE OF INTRAOPERATIVE ULTRASONOGRAPHY IN ASSESSING THORACIC RECURRENT LARYNGEAL NERVE LYMPH NODES IN PATIENTS WITH ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 35-35
Author(s):  
Hong Yang
Keyword(s):  
Esophageal Cancer ◽  
Recurrent Laryngeal Nerve ◽  
Predictive Value ◽  
Conflicts Of Interest ◽  
Nodal Metastasis ◽  
Laryngeal Nerve ◽  
Intraoperative Ultrasonography ◽  
Nodal Metastases ◽  
Thoracic Esophageal Cancer ◽  
Significant Difference

Abstract Background To evaluate the ability of intraoperative ultrasonography (IU) to detect recurrent laryngeal nerve (RLN) nodal metastases in esophageal cancer patients. Methods Sixty patients with esophageal cancer underwent IU, computed tomography (CT), and endoscopic ultrasonography (EUS) to assess for RLN nodal metastasis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were compared. Results The sensitivities of IU, CT, and EUS in diagnosing right RLN nodal metastases were 71.4%, 14.3%, and 30.0%, respectively, and a significant difference among these three examinations was observed (c2 = 10.077, P = .006). The specificities of IU, CT, and EUS for diagnosing right RLN nodal metastasis were 67.4%, 97.8%, and 95.0%, respectively, and a significant difference was observed (c2 = 21.725, P < .001). No significant differences in either PPV or NPV were observed when diagnosing right RLN nodal metastases. For diagnosis of left RLN lymph nodal metastases, the sensitivities of IU, CT, and EUS were 91.7%, 16.7%, and 40.0% respectively. There was a significant difference among these diagnostic sensitivities (c2 = 14.067, P = .001). The specificities of IU, CT, and EUS for diagnosis of left RLN nodal metastases were 79.2%, 100%, and 82.5%, respectively and a significant difference was observed (c2 = 10.819, P = .004). No significant differences were observed in PPV or NPV for these examinations when diagnosing left RLN nodal metastases. Conclusion Intraoperative ultrasonography showed superior sensitivity compared with preoperative CT or EUS in detecting RLN lymph node metastasis in patients with thoracic esophageal cancer. Disclosure All authors have declared no conflicts of interest.

VS01.06: THORACOSCOPIC EXTENDED LYMPHADENECTOMY FOR EGJ CANCER: AN OPTION TO LEARN FROM THE EAST

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 45-45
Author(s):  
Simone Giacopuzzi ◽  
Jacopo Weindelmayer ◽  
Giovanni De Manzoni
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Recurrent Laryngeal Nerve ◽  
Esophagogastric Junction ◽  
Conflicts Of Interest ◽  
Laryngeal Nerve ◽  
Extended Lymphadenectomy ◽  
Node Dissection ◽  
Node Metastasis ◽  
The Right

Abstract Description Extended thoracoscopic lymphadenectomy is not common practice in Western countries in patients with adenocarcinoma of the esophagogastric junction. In this video we present a case of a patient with siewert I adenocarcinoma with lymph node metastasis to the right recurrent laryngeal nerve not treated with neoadjuvant therapy, due to comorbidity. The operation was: extended thoracoscopic en-block lymph node dissection. video will be edited in a more rigorous manner Disclosure All authors have declared no conflicts of interest.

P152 CLINICAL PREDICTIVE MODEL OF LYMPH NODE METASTASIS AT RIGHT RECURRENT LARYNGEAL NERVE ZONE IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Li Zhigang ◽  
Li Baiwei ◽  
Li Bin ◽  
Yang Yang
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Esophageal Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Node Metastasis ◽  
Short Diameter

Abstract Aim The aim of this study is to establish a clinical predictive standard for lymph node metastasis at this location by retrospectively comparing the traditional imaging findings of RRLN lymph nodes in esophageal squamous cell carcinoma with postoperative pathology. Background The right recurrent laryngeal nerve (RRLN) is the zone most prone to lymph node metastasis of esophageal squamous cell carcinoma. Although the survival benefit is large after surgical dissection, however, the postoperative mortality rate is significantly increased if the nerve is injured. How to selectively perform lymph node dissection at this location has always been a clinical problem that needs to be addressed. In the past, clinical evaluations mostly used lymph node short diameter ≥1cm as the diagnostic criteria for metastasis, which significantly underestimated the actual clinical situation. Methods 308 patients with thoracic esophageal squamous cell carcinoma who underwent surgical treatment in Shanghai Chest Hospital from Jan 2018 to Dec 2018 were retrospectively analyzed. According to imaging 1mm layer thickness enhanced CT as a tool, the RRLN lymph node short diameter (ctNd) size was measured. All patients were divided into four groups: (A) CT images without RRLN lymph node, (B) CT images with RRLN lymph node was 0<ctNd<5mm, (C) CT images with RRLN lymph node was 5mm≤ctNd<10mm, (D) CT images with RRLN lymph node was ctNd≥10mm. The RRLN lymph node metastasis of each group was analyzed, and the influencing factors were analyzed to establish a predictive model. Results Among all patients, 87.6% of the patients had lymph nodes detected in the RRLN surgical specimens. The sampling rate was 14.5% (121/832), the RRLN lymph node metastasis rate was 19.48%, and the total lymph node metastasis rate was 48.7%. RRLN lymph nodes (57.1%) (A-132, B-43, C-125, D-9) were seen in the preoperative CT scan of 176 patients. The postoperative pathological RRLN lymph node metastasis rate was 9.1%, 18.6%, 27.2% and 66.7%, respectively (P=0.01). Multivariate analysis showed that ctNd, tumor location and N stage were risk factors for RRLN lymph node metastasis (P<0.05). The risk of upper esophageal cancer metastasis was higher than middle segment esophageal cancer (28.2% vs 18.6%, P<0.05). The higher the risk of right laryngeal lymph node metastasis was detected in the later N stage (cN0-13.2%, cN1-21.5%, cN2-46.7%, P<0.05). The 6.5mm short diameter of RRLN lymph nodes on CT scan is the critical value of metastasis at this position (sensitivity 50%, specificity 83.5%), and the higher the risk of metastasis was seen in the larger the short diameter (P<0.05). Conclusion More than 6.5mm short diameter in the CT scan image should be the clinical predictor of lymph node metastasis of the right recurrent laryngeal nerve. The higher risk of metastasis was seen in the greater short diameter. Upper esophageal cancer and multiple lymph node metastasis increase the risk of RRLN lymph node metastasis. Key words esophageal cancer, lymph node metastasis, recurrent laryngeal nerve, computed tomography

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