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 A NOVEL SCORING SYSTEM FOR RISK OF PAPILLARY THYROID CANCER METASTASES IN LYMPH NODES POSTERIOR TO THE RIGHT OF THE RECURRENT LARYNGEAL NERVE

2020 ◽  
Author(s):  
Jianbo Li ◽  
Gaofei He ◽  
Yifan Tong ◽  
Li Tao ◽  
Lei Xie ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Recurrent Laryngeal Nerve ◽  
Scoring System ◽  
Central Compartment ◽  
Laryngeal Nerve ◽  
Papillary Thyroid ◽  
Node Metastasis ◽  
The Right ◽  
Development And Validation

Background: Papillary thyroid carcinoma (PTC) can frequently metastasize to the cervical lymph node, especially in the central compartment. Some surgeons believe that dissection posterior to the right recurrent laryngeal nerve lymph node (PRRLN-LN) is unnecessary because of the low metastasis rate and high complication risk. However, persistent metastatic lymph nodes may have a higher recurrence rate, surgical risk, and complications. Thus, it is important to distinguish patients who require PRRLN-LN dissection. The aim of this study was to identify the risk factors for PRRLN-LN metastasis (LN-prRLN), and to establish a scoring system, to help determine whether PRRLN-LN dissection is required in PTC patients. Methods: The study comprised 821 patients with primary PTC in the right or both lobes who had undergone right lobectomy or total thyroidectomy with only right, or bilateral central compartment dissection with/without lateral neck dissection, between January 2010 and June 2016 in our institution. Participants were randomly allocated to development and validation cohorts in a 2:1 ratio. A nomogram-based predictive model for LN-prRLN was established based on the risk factors identified in the development cohort. Results: LN-prRLN was diagnosed pathologically in 15.1% (124/821) of patients from the entire cohort. Multivariate analysis identified age (odds ratio [OR] 0.964, 95% confidence interval [CI] 0.945–0.983; P<0.001), tumor size (OR 1.536, 95%CI 1.135–2.079; P=0.005), extrathyroidal extension (OR 2.271, 95%CI 1.368–3.770; P=0.002), clinically-involved right central compartment lymph node metastasis (OR 1.643, 95%CI 1.055–2.559; P=0.028), and right lateral lymph node metastasis (OR 4.271, 95%CI 2.325–7.844; P<0.001) as predictors of LN-prRLN. A risk model was established and well validated. Calibration curves to evaluate the nomogram in both the development and validation cohorts revealed a C-index of 0.756±0.058 and 0.745±0.042, respectively. Conclusions: Our scoring system may be useful for helping surgeons to decide which patients should undergo dissection of the PRRLN-LN. Abbreviations: ATA = American Thyroid Association; CCD = Central compartment dissection; CI = Confidence interval; C-index = The concordance index; ETE = Extrathyroidal extension; FNA = Fine-needle aspiration; LNM = Lymph node metastasis; LN-prRLN = Posterior to the right recurrent laryngeal nerve lymph node metastasis; OR = Odds ratio; PRRLN-LN = Posterior to the right recurrent laryngeal nerve lymph node; PTC = Papillary thyroid carcinoma; RLN = Recurrent laryngeal nerve.

scholarly journals Model of lymph node metastasis posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma

2018 ◽  
Vol Volume 10 ◽  
pp. 2449-2455 ◽  
Author(s):  
Yi Luo ◽  
Xiao-Cheng Xu ◽  
Jie Shen ◽  
Jing-Jing Shi ◽  
Si Lu ◽  
...  
Keyword(s):  
Lymph Node ◽  
Papillary Thyroid Carcinoma ◽  
Lymph Node Metastasis ◽  
Thyroid Carcinoma ◽  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Papillary Thyroid ◽  
Node Metastasis ◽  
The Right

scholarly journals Recurrent laryngeal nerve monitoring during totally robot-assisted Ivor Lewis esophagectomy

2020 ◽  
Vol 405 (8) ◽  
pp. 1091-1099
Author(s):  
J. I. Staubitz ◽  
P. C. van der Sluis ◽  
F. Berlth ◽  
F. Watzka ◽  
F. Dette ◽  
...  
Keyword(s):  
Lymph Node ◽  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Node Dissection ◽  
Robot Assisted ◽  
Nerve Monitoring ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Vocal Cord Paresis ◽  
The Right

Abstract Purpose The robot-assisted approach for Ivor Lewis esophagectomy offers an enlarged, three-dimensional overview of the intraoperative situs. The vagal nerve (VN) can easily be detected, preserved, and intentionally resected below the separation point of the recurrent laryngeal nerve (RLN). However, postoperative vocal cord paresis can result from vagal or RLN injury during radical lymph node dissection, presenting a challenge to the operating surgeon. Methods From May to August 2019, 10 cases of robot-assisted minimally invasive esophagectomy (RAMIE) with extended 2-field lymphadenectomy, performed at the University Medical Center Mainz, were included in a prospective cohort study. Bilateral intermittent intraoperative nerve monitoring (IONM) of the RLN and VN was performed, including pre- and postoperative laryngoscopy assessment. Results Reliable mean signals of the right VN (2.57 mV/4.50 ms) and the RLN (left 1.24 mV/3.71 ms, right 0.85 mV/3.56 ms) were obtained. IONM facilitated the identification of the exact height of separation of the right RLN from the VN. There were no cases of permanent postoperative vocal paresis. Median lymph node count from the paratracheal stations was 5 lymph nodes. Conclusion IONM was feasible during RAMIE. The intraoperative identification of the RLN location contributed to the accuracy of lymph node dissection of the paratracheal lymph node stations. RLN damage and subsequent postoperative vocal cord paresis can potentially be prevented by IONM.

PS01.191: LAPAROSCOPIC TRANSHIATAL LOWER MEDIASTINAL LYMPHADENECTOMY FOR ESOPHAGOGASTRIC JUNCTIONAL CANCER: THE INFRACARDIAC BURSA AS A LANDMARK

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 104-104
Author(s):  
Yasunori Kurahashi ◽  
Tatsuro Nakamura ◽  
Rie Ozawa ◽  
Yasutaka Nakanishi ◽  
Hirotaka Niwa ◽  
...  
Keyword(s):  
Lymph Node ◽  
Esophagogastric Junction ◽  
Conflicts Of Interest ◽  
Ventral Side ◽  
Dorsal Side ◽  
Node Dissection ◽  
Mediastinal Lymphadenectomy ◽  
Operating Field ◽  
Esophagogastric Junction Cancer ◽  
The Right

Abstract Background Esophagogastric junction cancer has been increasing recently. As a result, opportunities to perform transhiatal lower mediastinal lymphadenectomy are also increasing. Laparoscopic surgery is useful because the operating field of this site is too deep and narrow to perform laparotomy. But the anatomy of this area is not sufficiently clarified, and since there are few structures as landmarks, it is difficult to set the range and depth of lymph node dissection. Methods We have been verifying anatomically and embryologically the infracardiac bursa (ICB) identified as a closed lumen between the esophagus and the right crus of the diaphragm during an operation. We standardized the procedure of transhiatal lower mediastinal lymphadenectomy setting several landmarks including ICB. Results In transhiatal lower mediastinal lymphadenectomy, it is possible to do a precise lymphadenectomy by setting several landmarks including the ICB and standardizing each procedure on the ventral side, dorsal side, and both sides of the esophagus. In the case of advanced cancer which invades organs around the hiatus, it is difficult to perform routine dissection by using the infracardiac bursa or the dissectable layer. Understanding of the anatomy of this area will support the safe and precise lymphadenectomy. Conclusion In this presentation, we will show the procedure of transhiatal lower mediastinal lymphadenectomy using the ICB as a landmark. Disclosure All authors have declared no conflicts of interest.

scholarly journals The Lymph Node Metastasis and Lymph Node Dissection in Cancer of the Right Colon.

1992 ◽  
Vol 45 (6) ◽  
pp. 823-828
Author(s):  
S. Yamaguchi ◽  
S. Ohki ◽  
T. Jo ◽  
S. Imai ◽  
K. Matsuo ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Node Dissection ◽  
Node Dissection ◽  
Right Colon ◽  
Node Metastasis ◽  
The Right

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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