Prophylactic Cervical Lymph Node Dissection in Thoracoscopic Esophagectomy for Esophageal Cancer Increases Postoperative Complications and Does Not Improve Survival

Abstract Background The aim of this study was to evaluate the impact of cervical lymph node dissection on acid and duodenogastroesophageal reflux (DGER) in patients undergoing transthoracic esophagectomy with gastric tube reconstruction and intrathoracic esophagogastrostomy. Methods Thirty one patients receiving transthoracic esophagectomy gastric tube reconstruction by intrathoracic esophagogastrostomy were subjected and divided into two groups: two field lymph node dissection group (the 2F group) and three field lymph node dissection group (the 3F group). All patients underwent 24h pH and bilirubin monitoring and gastrointestinal endoscopy one year after surgery. The results of 24h pH and bilirubin monitoring, endoscopic findings, and reflux symptoms, were compared between two groups. Results No acid reflux was observed in the 2F group, whereas it was observed in 6 (40%) of the 3F group (P = 0.023). DGER was observed in 2 patients (13%) of the 2F groups, whereas it was observed in 8 (53%) of the 3F group (P = 0.007). The percentage time of acid reflux in the 3F group was significant higher than that in the 2F group (median 0.8 vs 0%, P = 0.008). The percentage time of bile reflux in the 3F group was also significantly higher than that in the 2F group (median 2.600 vs 0%, P = 0.027). Four patients (25%) had reflux esophagitis in the 2F group, and nine patients (60%) had reflux esophagitis in the 3F group (P = 0.048). Conclusion Cervical lymph node dissection increases acid reflux and duodenogastroesophageal reflux, and can lead to the increase of the incidence of reflux esophagitis in patient with intrathoracic esophagogastrostomy. Disclosure All authors have declared no conflicts of interest.

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Role of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid and parathyroid surgery

Journal of International Medical Research ◽

10.1177/0300060520952646 ◽

2020 ◽

Vol 48 (9) ◽

pp. 030006052095264

Author(s):

Yuwei Ling ◽

Jing Zhao ◽

Ye Zhao ◽

Kaifu Li ◽

Yajun Wang ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Dissection ◽

Cervical Lymph Node ◽

Intraoperative Neuromonitoring ◽

Central Lymph Node Metastasis ◽

Node Dissection ◽

Central Lymph Node ◽

Node Metastasis ◽

Cervical Lymph Node Dissection ◽

Central Lymph

Objective To investigate whether intraoperative neuromonitoring (IONM) has a significant advantage in reducing the incidence of recurrent laryngeal nerve (RLN) injury. Methods Patients who underwent thyroid and parathyroid surgery from October 2012 to December 2017 at the Center for Thyroid and Breast Surgery of Xuanwu Hospital were retrospectively analyzed. They were divided into the IONM group and visualization alone group (VA group) according to whether IONM was used. Results In total, 1696 nerves at risk of injury (IONM group, n = 1104; VA group, n = 592) were included in the analysis. Among the high-risk nerves, permanent damage occurred in no cases in the IONM group but in one case in the VA group. Because the higher proportion of central lymph node metastasis caused difficulties in central cervical lymph node dissection and identification of the RLN, the patients undergoing lateral cervical lymph node dissection in the VA group had a significantly higher risk of postoperative RLN injury (11.76% vs. 0.00%). Conclusion IONM technology has advantages in protection of the RLN, especially in high-risk nerves and patients with a high proportion of central lymph node metastasis who require central and lateral cervical lymph node dissection.

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