RA02.01: COMPARISON OF THREE-FIELD VERSUS TWO-FIELD LYMPHADENECTOMY FOR THORACIC MIDDLE AND LOWER ESOPHAGEAL CANCER: POST-OPERATIVE RESULTS OF A RANDOMIZED CONTROLLED TRIAL

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 19-20
Author(s):  
Bin Li ◽  
Jiaqing Xiang ◽  
Yawei Zhang ◽  
Jie Zhang ◽  
Yihua Sun ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Postoperative Complications ◽  
Lymph Nodes ◽  
Conflicts Of Interest ◽  
Tumor Staging ◽  
Operating Time ◽  
Thoracic Esophageal Cancer ◽  
Term Survival

Abstract Background Patients with esophageal cancer can benefit from extended lymphadenectomy. However, the role of 3-field lymphadenectomy is unclear, and the extent of lymphadenectomy for thoracic esophageal cancer is still under discussion. Methods From June 2013 to November 2016, 400 patients with middle and lower thoracic esophageal cancer were randomly assigned to receive 3-field (3FL, n = 200) or the 2-field (2FL, n = 200) lymphadenectomy. The postoperative complications, according to the Clavien-Dindo classification, and lymph node metastasis were compared on the basis of intention-to-treat principle. Results Baseline characteristics were balanced between the 2 arms. There were 187 patients (93.5%) had squamous cell carcinoma in 3FL arm, and 192 (96.0%) in the 2FL arm, P = 0262. According to the pathological reports, T staging in the 2 arms were comparable, however more N3 patients in the 3FL arm (10.5%, 21/200) than that in the 2FL arm (10%, 5/200), P = 0040. Consequently, less TNM staging I patients in the 3FL arm (16.0%, 32/200) than that in the 2FL arm (25.5%, 51/200), P = 0.019. Operating time was significantly longer in the 3FL arm (median, 183 vs. 168 [2FL] minutes, P < 0.001). Six patients in the 3FL arm (3%, 6/200) had reintubation, whereas no reintubation in the 2 FL arm (0%, 0/200), P = 0.030. Other postoperative complications were comparable in the 2 arms. One patient in the 2-field arm died of chyloperitoneum. According to the Clavien-Dindo classification of surgical complications, the distribution of severity were similar between the 2 arms, P = 0.416. More lymph nodes were resected in the 3FL arm (Median, 37 vs. 24 [2FL], P < 0.001). Lymph nodes resected in the mediastinum and upper abdomen were comparable between the 2 arms. 44 patients (22%) in the 3FL arm had positive lymph nodes. Conclusion Compared with 2-field lymphadenectomy, 3-field lymphadenectomy doesn’t increase the surgical risks for patients with thoracic esophageal cancer. 3-field lymphadenectomy can be performed safely, removing unforeseen cervical positive lymph node, and offering more accurate tumor staging. Long-term survival analysis under protocol will clarify the role of 3-field lymphadenectomy for esophageal cancer. Disclosure All authors have declared no conflicts of interest.

scholarly journals Surgical Benefits of Prone Position Thoracoscopic Esophagectomy Over Open Thoracic and Thoracoscopic Esophagectomy in Left Lateral Decubitus Position: A Literature Review

2020 ◽  
pp. 1-8
Author(s):  
Kazuo Koyanagi ◽  
Kazuo Koyanagi ◽  
Kentaro Yatabe ◽  
Miho Yamamoto ◽  
Soji Ozawa ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Postoperative Complications ◽  
Lymph Nodes ◽  
Mediastinal Lymph Node ◽  
Minimally Invasive Esophagectomy ◽  
Node Dissection ◽  
Invasive Esophagectomy ◽  
Left Lateral Decubitus Position ◽  
Lateral Decubitus

Objective: We reviewed the surgical outcomes of minimally invasive esophagectomy (MIE), especially the number of lymph nodes retrieved, for the patients with esophageal cancer to clarify the surgical benefits of MIE in patients with esophageal cancer. Material and Methods: A systematic literature search was performed, and articles that fully described the surgical results of MIE were selected. Parameters such as operative time, blood loss, the number of lymph nodes retrieved, and postoperative complications were compared among patients undergoing minimally invasive esophagectomy (MIE) in the left lateral decubitus position (MIE-LP), MIE in the prone position (MIE-PP), and open thoracic esophagectomy (OE). Results: The conversion rate from MIE to OE was very low. MIE-PP was associated with lower blood loss than OE and MIE-LP. Results of a multicenter randomized controlled trial demonstrated that pneumonia and recurrent laryngeal nerve paralysis in MIE-PP significantly reduced compared with OE. Although postoperative complications were not different between MIE-PP and MIE-LP, the number of lymph nodes retrieved in MIE-PP was higher than that in MIE-LP. Conclusion: MIE-PP has potential benefits in terms of less surgical invasiveness and improvement of mediastinal lymph node dissection. A prospective randomized control trial using a large number of cases and long-term follow-up is recommended for analyses of appropriate mediastinal lymph node dissection and its impact on oncological benefit.

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.

scholarly journals Significance of Tumor Length as Prognostic Factor for Esophageal Cancer

2013 ◽  
Vol 98 (3) ◽  
pp. 234-240 ◽  
Author(s):  
Arife Zeybek ◽  
Abdullah Erdoğan ◽  
Kemal Hakan Gülkesen ◽  
Makbule Ergin ◽  
Alpay Sarper ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Specific Treatment ◽  
Disease Free Survival ◽  
Curative Surgery ◽  
Thoracic Esophageal Cancer ◽  
Clinicopathologic Characteristics ◽  
Term Survival ◽  
Tumor Length ◽  
Significant Difference

Abstract Our study indicated the relationship between tumor length and clinicopathologic characteristics as well as long-term survival in esophageal cancer. A total of 116 patients who underwent curative surgery for thoracic esophageal cancer with standard lymphadenectomy in 2 fields between 2000 and 2010 were included in the study. The medical records of these patients were retrospectively reviewed. The patients with tumor length ≥3 cm had a highly significant difference in the involvement of adventitia and lymph node stations. The patients with tumor length ≤3 cm had significantly lower rates of involvement of the adventitia and lymph node stations. Tumor length could have a significant impact on both the overall survival and disease-free survival of patients with resected esophageal carcinomas and may provide additional prognostic value to the current tumor, node, and metastasis staging system before patients receive any cancer-specific treatment.

RA09.01: NORMAL LYMPH NODE APPEARANCE IN THE THORAX

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 39-40
Author(s):  
Tomas Hansen ◽  
Magnus Nilsson ◽  
Daniel Lindholm ◽  
Johan Sundström ◽  
Jakob Hedberg
Keyword(s):  
Computed Tomography ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Conflicts Of Interest ◽  
Clinical Stage ◽  
Diagnostic Assessment ◽  
Clinical Staging ◽  
Short Axis ◽  
Nodal Stage

Abstract Background Modern treatment of esophageal cancer is multimodal and highly dependent on detailed diagnostic assessment of clinical stage which includes nodal stage. Clinical appraisal of nodal stage requires knowledge of normal radiological appearance, information of which is scarce. We aimed to describe lymph node appearance on computed tomography (CT) investigations in a randomly selected cohort of healthy subjects. Methods In a sample of 426 healthy Swedish volunteers aged 50–64 years, CT scans were studied in detail concerning intrathoracic node stations relevant in clinical staging of esophageal cancer. With stratification for sex, the short axis of visible lymph nodes was measured and distribution of lymph node sizes was calculated as well as proportion of patients with visible nodes above 5 and 10 millimeters for each station. Probability of having any lymph node station above 5 and 10 millimeters was calculated with a logistic regression model adjusted for age and sex. Results In the 214 men (age 57.3 ± 4.1 years) and 212 women (57.8 ± 4.4years) included in the study, a total of 309 (72.5%) had a lymph node with a short axis of 5 mm or above was seen in one of the node stations investigated. When using 10 mm as a cutoff, nodes were visible in 29 (6.81%) patients. Men had three times higher odds of having any lymph node with short axis 5 mm or above (OR 3.03 95% CI 1.89–4.85, P < 0.001) as well as 10mm or above (OR 2.31 95% CI 1.02–5.23, P = 0.044) compared to women. Higher age was not associated with propensity for lymph nodes above 5 or 10 millimeters in this sample. Conclusion In a randomly selected cohort of patients between 50 and 64 years, almost ten percent of the men and four percent of the women had lymph nodes above ten millimeters, most frequently in the subcarinal station (station 107). More than half of the patients had nodes above five millimeters on computed tomography and men were much more prone to have this finding. The probability of finding lymph nodes in specific stations relevant of esophageal cancer is now described. Disclosure All authors have declared no conflicts of interest.

PS02.167: IMPACT OF POSTOPERATIVE COMPLICATIONS AFTER RESECTION OF ESOPHAGUS FOR CARCINOMA ON LONG-TERM SURVIVAL

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 169-169
Author(s):  
Martin Snajdauf ◽  
Tomas Harustiak ◽  
Alexandr Pazdro ◽  
Robert Lischke
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Postoperative Complications ◽  
Conflicts Of Interest ◽  
Neoadjuvant Treatment ◽  
Chyle Leak ◽  
Term Survival ◽  
Long Term Survival ◽  
The Impact

Abstract Background Esophagectomy with 2–3 field lymph node dissection is one of the most invasive surgical treatment for malignancy and is still associated with a high mortality and morbidity despite improvements in surgical techniques and postoperative management. The impact of postoperative complications on perioperative morbidity is widely accepted. But the impact of postoperative complications on long-term survival remains controversial. Methods A retrospective analysis was performed on patient who underwent transthoracic esophagectomy with intrathoracic anastomosis for esophageal cancer between January 2005 and December 2012 in our department (415 patients). We excluded non-radical resections (R1, R2 – 27 patients, 6.5%) and patients who died within 90 day after operation (20 patients, 4.8%). Data on gender, BMI, histologic diagnosis, tumor staging, neoadjuvant treatment, comorbidities, technical complications and postoperative medical complications were reviewed. Considered postoperative complications were anastomotic leak, empyema, chyle leak, pneumonia, ARDS, cardiac arrhythmia, wound infection and urinary tract infection. We analysed separately extrapolated serious complications Clavien Dindo 3–4 and their possible impact on overall survival. Prognostic factors were assessed by multivariate analysis. Results Total number of analysed patients was 363. The median follow up was 8.5 years. From the baseline characteristics, the presence of atrial fibrillation (P = 0.0157, HR 2.376) and hypertension (P = 0.0093, HR 1.488), higher staging pT3–4 (0.0146, HR 1.437) and presence of lymph node metastasis pN + (P < 0.001, HR 2.263) had a negative impact on overall survival. Among the postoperative complications, only chyle leak (P = 0.0327, HR 4.023) had a negative prognostic factor on overall survival. Conclusion In this single institution series, among the postoperative complications only chylothorax affect negatively the overall survival. Accurate ligation of resected thoracic duct stumps to minimize chyle leak is important to improve outcomes. The influence of others postoperative complications wasn’t significant. We assume important to exclude postoperative mortality from analysis to prevent bias. Disclosure All authors have declared no conflicts of interest.

PS01.220: COMPARISON OF SHORT-TERM OUTCOMES BETWEEN RAMIE AND VAMIE IN TREATMENT MIDDLE THORACIC ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 112-112
Author(s):  
Yidan Lin ◽  
Hanyu Deng
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Lymph Nodes ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Operation Time ◽  
Short Term ◽  
Thoracic Esophageal Cancer ◽  
Comparable Rate ◽  
Invasive Esophagectomy

Abstract Background Whether robot-assisted minimally invasive esophagectomy (RAMIE) has any advantages over video-assisted minimally invasive esophagectomy (VAMIE) remains controversial. In this study, we tried to compare the short-term outcomes of RAMIE with that of VAMIE in treating middle thoracic esophageal cancer from a single medical center. Methods Consecutive patients undergoing RAMIE or VAMIE for middle thoracic esophageal cancer from April 2016 to April 2017 were prospectively included for analysis. Baseline data and pathological findings as well as short-term outcomes of these two group (RAMIE group and VAMIE group) patients were collected and compared. A total of 84 patients (RAMIE group: 42 patients, VAMIE group: 42 patients) were included for analysis. Results The baseline characteristics between the two groups were comparable. RAMIE yielded significantly larger numbers of total dissected lymph nodes (21.9 and 17.8, respectively; P = 0.042) and right recurrent laryngeal nerve (RLN) lymph nodes (2.1 and 1.2, respectively; P = 0.033) as well as abdominal lymph nodes (10.8 and 7.7, respectively; P = 0.041) than VAMIE. Even though RAMIE may consume more overall operation time, it could significant decrease total blood loss compared to VAMIE (97 and 161 ml, respectively; P = 0.015). Postoperatively, no difference of the risk of major complications or hospital stay was observed between the two groups. Conclusion RAMIE had significant advantage of lymphadenectomy especially for dissecting RLN lymph nodes over VAMIE with comparable rate of postoperative complications. Further randomized controlled trials are badly needed to confirm and update our conclusions. Disclosure All authors have declared no conflicts of interest.

PS02.131: PATTERN OF LYMPHATIC METASTASIS OF CERVICAL ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 158-158
Author(s):  
Jiancheng Li ◽  
Xiuling Shi
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Conflicts Of Interest ◽  
Mediastinal Lymph Node ◽  
Radical Resection ◽  
Cervical Esophageal Cancer ◽  
Cervical Lymph Nodes ◽  
Node Metastasis

Abstract Background Cervical esophageal cancer were rarely surgeryed Analysis and discussion of lymph node metastasis of cervical esophageal cancer Methods From July 2008 to June 2017, 10 cases of successful esophagectomy of cervical esophageal cance in our hospital underwent radical resection. Surgical dissection range was the neck and the upper mediastinum. A total of 231 lymph nodes were dissected. The lymph nodes were summarized and grouped in different ways, and analyzed the law of lymph node metastasis. Results 7 cases of esophageal cancer, lymph node metastasis occurred, and the rate of lymph node metastasis was 70% (7/10), of which 1 case was T1b stage. 17 lymph node metastases, the degree of lymph node metastasis was 7.36% (17/231), including 4 esophageal lymph nodes, 12 cervical lymph nodes and 1 upper right mediastinal lymph node. Conclusion Cervical esophageal cancer lymph node metastasis can spread occur early metastasis, and the metastasis site were mainly in neck.. Disclosure All authors have declared no conflicts of interest.

scholarly journals Complications After Lymph Node Dissection Along Bilateral Recurrent Laryngeal Nerves Through Right Thoracic Approach in the Patients With Thoracic Esophageal Cancer

2021 ◽  
Author(s):  
Ligong Yuan ◽  
Feng Li ◽  
Yousheng Mao ◽  
Jie He ◽  
Shugeng Gao ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Postoperative Complications ◽  
Hospital Stay ◽  
Anastomotic Leakage ◽  
New Technologies ◽  
Cell Cancer ◽  
Pulmonary Complications ◽  
Thoracic Esophageal Cancer ◽  
Thoracic Approach

Abstract Background: Extensive lymph nodes dissection can improve the accuracy of tumor staging and prognosis of the patients with thoracic esophageal cancer, palsy of recurrent laryngeal nerve (RLN) caused by the lymph node (LN) dissection along RLN chain also increase postoperative complications and may affect the prognosis. This study aimed to evaluate the associated postoperative complications after LN dissection along RLNs in the patients with thoracic esophageal squamous cell cancer (ESCC).Methods: 339 eligible patients with thoracic ESCC who underwent radical McKeown or Ivor-Lewis esophagectomy by open or VATS procedures through right thoracic approach with LN dissection along bilateral RLNs were included in this study. Univariate and multivariate logistic regression analysis were conducted to assess the correlation of RLN paralysis (RLNP) with other post-operative complications. Results: 39 of the 339 patients were diagnosed with RLNP (11.5%) postoperatively. The incidence of RLNP in three-field (3FL) LN dissection was significantly higher than that in the two-field (2FL) LN dissection ( 24.0% vs 8.0%, P＜0.001). Compared with the patients without RLNP, the patients with it had a significantly higher incidence of postoperative anastomotic leakage (P=0.029), pulmonary complications (P=0.001) and much longer hospital stay (P=0.001). Two patients died of respiratory failure within 30 days caused by RLNP and were treated by reintubation. Conclusion: RLNP after LN dissection along bilateral RLN in thoracic ESCC was associated with much higher morbidity such as pulmonary complications, anastomotic leakage, and much longer hospital stay. New technologies are required to reduce RLNP incidence and its associated complications.

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