Abstract
Description
We have modified our procedures of lymphadenectomy, with the purpose of radical lymph node dissection, because we believe that radical lymph node dissection along bilateral RLNs may be crucial for post-operative accurate staging, local control and better prognosis. Programmed lymphadenectomy includes several steps. Programmed extensive lymphadenectomy along right RLN included 3 steps: (1) Location of the right vagus nerve. (2) Loaction of the root of the right RLN. (3) Extensive lymphadenectomy. Programmed extensive lymphadenectomy along left RLN was conducted subsequently, which included 4 steps. (1) Esophageal suspension. (2) Lymph node rolling.(3) Location and identification of left RLN. (4) Extensive lymphadenectomy. During the whole procedure, we preferred to use blunt separation in the zones near the RLN, and preferred to use the ultrasound knife and scissors rather than electrical knife. The thoracic esophagus was not cut off during the procedure. After the thoracic procedures, we do the laparoscopic gastric dissociation and lymph node dissection. When metastasis to either RLN chains was confirmed by routine intra-operative frozen section, bilateral cervical lymphadenectomy was also performed. We divided the procedures into steps, which could have following advantages: more radical lymph node clearance with skeletonization of the nerves, reduced injuries due to definite location and identification of the nerves, more easier for surgeons to expose the surgical field and more easier for new-hands to master the procedures. Minimally invasive esophageactomy and thoracoscopic programmed extensive lymphadenectomy along the left and right RLNs in esophagectomy was feasible and safe. According to our study, programmed extensive lymphadenectomy yielded sufficient lymph nodes, with acceptable postoperative complications.
Disclosure
All authors have declared no conflicts of interest.
Radical Lymph Node Dissection for Cancer of the Thoracic Esophagus