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.

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.

PS02.246: SURGICAL OUTCOMES OF SURGICAL T4B THORACIC ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 192-192
Author(s):  
Norihisa Uemura ◽  
Tetsuya Abe ◽  
Eiji Higaki ◽  
Takahiro Hosoi ◽  
Byonggu An
Keyword(s):  
Esophageal Cancer ◽  
Prognostic Factor ◽  
Surgical Outcomes ◽  
Curative Resection ◽  
Conflicts Of Interest ◽  
Post Treatment ◽  
R0 Resection ◽  
Preoperative Treatment ◽  
Thoracic Esophageal Cancer ◽  
Significant Difference

Abstract Background Patients with surgical T4b (sT4b) thoracic esophageal cancer undergo exploratory thoracotomy or non-curative resection. However, in some cases, it is difficult to decide whether to perform exploratory thoracotomy without resection, or perform non-curative resection to the extent possible. The purpose of this retrospective study was to analyze surgical outcomes of sT4b thoracic esophageal cancer to clarify the optimal treatment strategy. Methods A total of 12 patients with sT4b thoracic esophageal cancer underwent exploratory thoracotomy (n = 7) or non-curative resection (n = 5) between January 2011 and December 2015. Of the seven patients who underwent exploratory thoracotomy, two underwent bypass surgery. In the five patients who underwent non-curative resection, gastric reconstruction was performed. Clinical data from these 12 patients were analyzed retrospectively. Results Compared to the seven patients who underwent exploratory thoracotomy (Ex group), the five patients who underwent non-curative resection (NC group) had a significantly longer period until the start of post-treatment (median, 23/57 (Ex/NC) days; P = 0.0027). No significant difference was observed in the postoperative survival period between the two groups (Median survival time (MST), 9/12 (Ex/NC) months; P = 0.55). In the prognostic factor analysis, patients with progressive disease (PD) responsiveness to preoperative treatment had a significantly poorer prognosis (MST, 13.5/5.5 (partial response-stable disease/PD) months; P = 0.01). On the other hand, patients with cStage 3 disease and who received postoperative chemoradiotherapy had a relatively good prognosis (cStage 3/4; MST 12.5/5.5 month, P = 0.09, postoperative chemoradiotherapy received/not received; MST 13/5 month, P = 0.11). The period until the start of post-treatment was not a prognostic factor. Conclusion Responsiveness to preoperative treatment was found to be a prognostic factor in patients with sT4b thoracic esophageal cancer. Thus, if patients show a poor response to preoperative treatment, R0 resection should be performed without exploratory thoracotomy. On the contrary, for patients with a good response to preoperative treatment, administration of post-operative chemoradiotherapy should be considered, while maintaining performance status without causing serious secondary injury. Disclosure All authors have declared no conflicts of interest.

Neuromonitoring of the recurrent laryngeal nerve in thyroid gland surgery – results and experiences

2021 ◽  
Vol 70 (2) ◽  
pp. 89-96
Author(s):  
Jiří Hložek ◽  
Jan Rotnágl ◽  
Jaromír Astl
Keyword(s):  
Thyroid Gland ◽  
Recurrent Laryngeal Nerve ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Laryngeal Nerve ◽  
Operative Strategy ◽  
Predictive Values ◽  
Group A ◽  
Group B ◽  
Neural Monitoring

Paresis of the recurrent laryngeal nerve (RLN) is one of the serious complications of thyroid and parathyroid gland surgery. The intraoperative neural monitoring (IONM) enables to verify the functionality of RLN. The aim of this study is to compare the incidence of postoperative RLN palsy in patients who underwent surgery with and without the use of IONM RLN and to evaluate the positive and negative predictive values, sensitivity, specifi city and accuracy of the method. Methods: Retrospective analysis of thyroid gland surgeries performed within the period from 1. 7. 2016 to 1. 7. 2018. A total of 467 operations were performed (780 nerves exposed). One hundred and thirty procedures (215 nerves) were carried out without IONM (group A). In total, 337 procedures (565 nerves) were performed with IONM (group B). Results: In group A, unilateral postoperative RLN paresis occurred in 7 cases (3.26%); 6 of them were temporary (2.79%) and 1 was permanent (0.47%). In group B, unilateral postoperative RLN paresis occurred in 33 cases (5.84%); 32 of them were temporary (5.66%) and 1 was permanent (0.18%). The incidence of postoperative RLN paresis related to the use of IONM was not considered statistically signifi cant. (Chi-square test: P = 0.146; Fisher‘s exact test: P = 0.2015, P = 0.4715). The sensitivity, specifi city, positive predictive value, negative predictive value and accuracy were 78.79%, 99.25%, 86.67%, 98.69%, and 98.05%, respectively. There was no case of bilateral postoperative RLN paresis. Conclusion: There was no statistically significant diff erence in the incidence of postoperative RLN palsy in patients who underwent surgery with IONM compared to the group without IONM. The high negative predictive value, specifi city and accuracy indicate high reliability of the method. The IONM provides the surgeon with valuable information regarding the functional status of the nerve. This knowledge allows for changing the operative strategy during the procedure. Keywords: intraoperative neural monitoring – IONM – recurrent laryngeal nerve injury – recurrent laryngeal nerve – thyroid surgery

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.

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.

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